Provider Demographics
NPI:1215971833
Name:WITZMANN, ANGELA RENA (CNS/APRN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENA
Last Name:WITZMANN
Suffix:
Gender:F
Credentials:CNS/APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3403 E RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-4744
Mailing Address - Country:US
Mailing Address - Phone:317-957-2000
Mailing Address - Fax:317-957-2050
Practice Address - Street 1:1522 W MORRIS ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46221-1629
Practice Address - Country:US
Practice Address - Phone:317-957-2500
Practice Address - Fax:317-957-2520
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN70000076A364SP0808X, 363LP0808X
IN28110617A163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200119010Medicaid
IN000000335051OtherANTHEM PIN NUMBER