Provider Demographics
NPI:1942503495
Name:WITTE, JENNIFER M (ARNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:WITTE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 FAWCETT AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-1911
Mailing Address - Country:US
Mailing Address - Phone:253-761-4200
Mailing Address - Fax:253-761-4201
Practice Address - Street 1:1304 FAWCETT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-1911
Practice Address - Country:US
Practice Address - Phone:253-761-4200
Practice Address - Fax:253-761-4201
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60255926363LF0000X
CA20278363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA338125OtherLNI
WA338129OtherLNI
WA2016165Medicaid
WA338127OtherLNI
WA336824OtherLNI
WA338122OtherLNI
WA336824OtherLNI
WAG8936772Medicare PIN
WA338127OtherLNI
WA338122OtherLNI
WAG8936774Medicare PIN