Provider Demographics
NPI:1356422562
Name:DEWITT, LINDA K (ARNP)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:K
Last Name:DEWITT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2517 17TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-6311
Mailing Address - Country:US
Mailing Address - Phone:208-743-4373
Mailing Address - Fax:208-743-3369
Practice Address - Street 1:2517 17TH ST STE B
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-6311
Practice Address - Country:US
Practice Address - Phone:208-743-4373
Practice Address - Fax:208-743-3369
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007060363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner