Provider Demographics
NPI:1942026638
Name:WITTMAYER, LINDSEY (FSS)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:WITTMAYER
Suffix:
Gender:F
Credentials:FSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 5TH ST W STE 1
Mailing Address - Street 2:
Mailing Address - City:BOTTINEAU
Mailing Address - State:ND
Mailing Address - Zip Code:58318-1204
Mailing Address - Country:US
Mailing Address - Phone:701-263-1049
Mailing Address - Fax:
Practice Address - Street 1:314 5TH ST W STE 1
Practice Address - Street 2:
Practice Address - City:BOTTINEAU
Practice Address - State:ND
Practice Address - Zip Code:58318-1204
Practice Address - Country:US
Practice Address - Phone:701-263-1049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator