Basic Information
| Provider Information | |||||||||
| NPI: | 1962780429 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WITMER | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 830 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ORRVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446672291 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306842015 | ||||||||
| FaxNumber: | 3306842075 | ||||||||
| Practice Location | |||||||||
| Address1: | 830 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ORRVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446672291 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306842015 | ||||||||
| FaxNumber: | 3306842075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2011 | ||||||||
| LastUpdateDate: | 08/01/2011 | ||||||||
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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 | 363LP2300X | 12479 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 12479-NP | 01 | OH | COA | OTHER |