MEDICARE: MS. VICKI LYNN WITMER N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	116620	CO

General Provider Information

NPI Number	:	1497734149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VICKI LYNN WITMER N.P.

Provider Business Mailing Address
First Line	:	813 ALYSON DR
Second Line	:
City	:	FT COLLINS
State	:	CO
Zip	:	80524-1512
Country	:	US
Telephone Number	:	970-472-0309
Fax Number	:

Provider Business Practice Location Address
First Line	:	8025 1ST ST STE. B
Second Line	:	RED FEATHER MEDICAL CLINIC
City	:	WELLINGTON
State	:	CO
Zip	:	80549
Country	:	US
Telephone Number	:	970-568-7800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	07/08/2007

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