Provider Demographics
NPI:1972196319
Name:WITT, CARLY (RN)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:WITT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2184 S RICE RD
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-4021
Mailing Address - Country:US
Mailing Address - Phone:805-798-3021
Mailing Address - Fax:
Practice Address - Street 1:552 UNIVERSITY RD
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93106-0001
Practice Address - Country:US
Practice Address - Phone:805-893-5361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95224804163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse