Provider Demographics
NPI:1932557295
Name:WITT, LEA M (NP-C)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:M
Last Name:WITT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:LEA
Other - Middle Name:M
Other - Last Name:WITT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:550 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-1421
Mailing Address - Country:US
Mailing Address - Phone:740-363-1904
Mailing Address - Fax:740-363-5288
Practice Address - Street 1:550 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1421
Practice Address - Country:US
Practice Address - Phone:740-363-1904
Practice Address - Fax:740-363-5288
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.19150363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0193565Medicaid