Provider Demographics
NPI:1801853064
Name:WITTMAN, WILLIAM F (CRNP)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:F
Last Name:WITTMAN
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-486-2202
Mailing Address - Fax:
Practice Address - Street 1:416 N BROAD ST
Practice Address - Street 2:
Practice Address - City:EMPORIUM
Practice Address - State:PA
Practice Address - Zip Code:15834-1402
Practice Address - Country:US
Practice Address - Phone:814-486-2202
Practice Address - Fax:814-486-0973
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP006174 B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS99525Medicare UPIN
PA035454Medicare ID - Type Unspecified