Basic Information
| Provider Information | |||||||||
| NPI: | 1396238853 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WITTMANN | ||||||||
| FirstName: | RENATE | ||||||||
| MiddleName: | H. | ||||||||
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| Credential: | REGISTERED NURSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 160 RED BRIDGE RD | ||||||||
| Address2: | |||||||||
| City: | LAKE ZURICH | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600472588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478471126 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 544 W DUNDEE RD | ||||||||
| Address2: | |||||||||
| City: | WHEELING | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474196974 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2018 | ||||||||
| LastUpdateDate: | 06/13/2018 | ||||||||
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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 | 163W00000X | 041230841 | IL | Y | Nursing Service Providers | Registered Nurse |
No ID Information.