Basic Information
| Provider Information | |||||||||
| NPI: | 1104124429 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WITTICH | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | KATHLEEN | ||||||||
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| Credential: | M.A., R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 734 REID PL | ||||||||
| Address2: | |||||||||
| City: | CASTLE ROCK | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801087458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202519880 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8565 S. POPLAR WAY | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7203482800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2011 | ||||||||
| LastUpdateDate: | 03/10/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 193937 | CO | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.