Provider Demographics
NPI:1760920581
Name:WITMAN, MATTHEW JAPINGA (CRNA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JAPINGA
Last Name:WITMAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3279 STUART ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-1713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12401 E 17TH AVE
Practice Address - Street 2:FLOOR #7
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2548
Practice Address - Country:US
Practice Address - Phone:720-848-6709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0992905367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered