Provider Demographics
NPI:1982045514
Name:WITTLER, ASHLEY A (NP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:A
Last Name:WITTLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4600 MEMORIAL DR
Mailing Address - Street 2:STE. 400
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-5368
Mailing Address - Country:US
Mailing Address - Phone:618-234-2390
Mailing Address - Fax:618-234-9936
Practice Address - Street 1:4600 MEMORIAL DR
Practice Address - Street 2:STE. 400
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5368
Practice Address - Country:US
Practice Address - Phone:618-234-2390
Practice Address - Fax:618-234-9936
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209010684363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209010684OtherIDFPR