Provider Demographics
NPI:1801639596
Name:WITGES, ZACHARY JOESPH (AGNP)
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:JOESPH
Last Name:WITGES
Suffix:
Gender:M
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 959203
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-8512
Mailing Address - Country:US
Mailing Address - Phone:618-234-2390
Mailing Address - Fax:314-996-7658
Practice Address - Street 1:4 MEMORIAL DR STE 230
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6704
Practice Address - Country:US
Practice Address - Phone:618-463-7874
Practice Address - Fax:314-996-7658
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024043178363L00000X
IL209.029825363LA2200X
IL209029825363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health