Provider Demographics
NPI:1730114356
Name:WITTMAIER, DEBRA (RN, PA)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:WITTMAIER
Suffix:
Gender:F
Credentials:RN, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 OLD CHATTANOOGA PIKE SW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-8566
Mailing Address - Country:US
Mailing Address - Phone:423-303-1959
Mailing Address - Fax:423-303-1870
Practice Address - Street 1:764 OLD CHATTANOOGA PIKE SW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311
Practice Address - Country:US
Practice Address - Phone:423-303-1959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN960363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP84359Medicare UPIN