Provider Demographics
NPI:1770313843
Name:WITTMAN, COLETTE NORBERT (LPN)
Entity type:Individual
Prefix:
First Name:COLETTE
Middle Name:NORBERT
Last Name:WITTMAN
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 1:2538 FORTESQUE AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-2410
Mailing Address - Country:US
Mailing Address - Phone:516-707-2561
Mailing Address - Fax:
Practice Address - Street 1:2538 FORTESQUE AVE
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-2410
Practice Address - Country:US
Practice Address - Phone:516-707-2561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255537-01164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse