Provider Demographics
NPI:1295343358
Name:WITT, RACHEL NICOLE (APRN)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:NICOLE
Last Name:WITT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4083 CLOUD PARK DR APT B6
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-8091
Mailing Address - Country:US
Mailing Address - Phone:937-701-9492
Mailing Address - Fax:
Practice Address - Street 1:2111 E STATE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2138
Practice Address - Country:US
Practice Address - Phone:740-566-4621
Practice Address - Fax:740-566-4622
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-15
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF01201157363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily