Provider Demographics
NPI:1851843353
Name:WITESMAN, SARAH ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ANNE
Last Name:WITESMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ANNE
Other - Last Name:CALLISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1075 SW GRANDVIEW AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5118
Mailing Address - Country:US
Mailing Address - Phone:414-798-3635
Mailing Address - Fax:541-476-2841
Practice Address - Street 1:1075 SW GRANDVIEW AVE STE 200
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5118
Practice Address - Country:US
Practice Address - Phone:414-798-3635
Practice Address - Fax:541-476-2841
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10140302-8906363A00000X
UT10140302-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant