Provider Demographics
NPI:1730143934
Name:BITTLE, SHEILA (PHD APRN PMH-BC)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:BITTLE
Suffix:
Gender:F
Credentials:PHD APRN PMH-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 E 100 S
Mailing Address - Street 2:#105
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1501
Mailing Address - Country:US
Mailing Address - Phone:801-532-7414
Mailing Address - Fax:801-532-2381
Practice Address - Street 1:1060 E 100 S
Practice Address - Street 2:#105
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1501
Practice Address - Country:US
Practice Address - Phone:801-532-7414
Practice Address - Fax:801-532-2381
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1057904405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1730143934OtherPHD APRN BC PSYCHIATRIC MENTAL HEALTH NURSE, BOARD CERTIFIED