Provider Demographics
NPI:1912474883
Name:WITZEL, JEANNETTE CHARLOTTE (RN)
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:CHARLOTTE
Last Name:WITZEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 GINKGO ST SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-7109
Mailing Address - Country:US
Mailing Address - Phone:707-972-9613
Mailing Address - Fax:
Practice Address - Street 1:30620 116TH AVE SE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092-3161
Practice Address - Country:US
Practice Address - Phone:253-931-4855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60403510163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse