Provider Demographics
NPI:1750627568
Name:WITCZAK, ESTHER DIANA (BSN, RN)
Entity type:Individual
Prefix:MRS
First Name:ESTHER
Middle Name:DIANA
Last Name:WITCZAK
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:MS
Other - First Name:ESTHER
Other - Middle Name:DIANA
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:240 UNION STATION PLAZA
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015
Mailing Address - Country:US
Mailing Address - Phone:484-526-2786
Mailing Address - Fax:484-893-7096
Practice Address - Street 1:240 UNION STATION PLAZA
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015
Practice Address - Country:US
Practice Address - Phone:484-526-2786
Practice Address - Fax:484-893-7096
Is Sole Proprietor?:No
Enumeration Date:2012-12-26
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN541192163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027837740001Medicaid