Provider Demographics
NPI:1740906536
Name:WITTHUHN, MICHELENE E (APRN)
Entity type:Individual
Prefix:
First Name:MICHELENE
Middle Name:E
Last Name:WITTHUHN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 COUNTY ROAD 70
Mailing Address - Street 2:
Mailing Address - City:STAPLETON
Mailing Address - State:NE
Mailing Address - Zip Code:69163-5300
Mailing Address - Country:US
Mailing Address - Phone:308-636-8590
Mailing Address - Fax:
Practice Address - Street 1:601 W LEOTA ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6525
Practice Address - Country:US
Practice Address - Phone:308-568-7075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE114522363L00000X
NE60430163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse