Provider Demographics
NPI:1912485038
Name:PITTS, WINONA BENITA (NP)
Entity Type:Individual
Prefix:
First Name:WINONA
Middle Name:BENITA
Last Name:PITTS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:WINONA
Other - Middle Name:BENITA
Other - Last Name:TATUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:484 E CARMEL DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-2812
Mailing Address - Country:US
Mailing Address - Phone:317-660-1379
Mailing Address - Fax:
Practice Address - Street 1:3851 N RIVER RD
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-3765
Practice Address - Country:US
Practice Address - Phone:765-463-1502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28201413A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health