Provider Demographics
NPI:1770200958
Name:WITTEMAN, MORGAN BAYLEE (NP)
Entity type:Individual
Prefix:MS
First Name:MORGAN
Middle Name:BAYLEE
Last Name:WITTEMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 W JACKSON ST APT 14
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-2846
Mailing Address - Country:US
Mailing Address - Phone:715-610-6399
Mailing Address - Fax:
Practice Address - Street 1:2301 W JACKSON ST APT 14
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:WI
Practice Address - Zip Code:54452-2846
Practice Address - Country:US
Practice Address - Phone:715-610-6399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1324333363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily