Provider Demographics
NPI:1356594899
Name:WITTER, ANDREA KAYLEEN (LPN)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:KAYLEEN
Last Name:WITTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11187 HEFNER RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45644-9628
Mailing Address - Country:US
Mailing Address - Phone:740-253-1651
Mailing Address - Fax:
Practice Address - Street 1:11187 HEFNER RD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:OH
Practice Address - Zip Code:45644-9628
Practice Address - Country:US
Practice Address - Phone:740-253-1651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 118840164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse