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NPI Code Detail

MEDICARE: MS. COLLEEN MARIE WITTE RN MS ANP

MEDICARE: MS. COLLEEN MARIE WITTE RN MS ANP
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
1363L00000XNurse PractitionerRNP421777CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
16124OTHERCANP CERTIFICATE

General Provider Information

NPI Number : 1689674988
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. COLLEEN MARIE WITTE RN MS ANP
Provider Business Mailing Address
First Line : 1247 ROSITA RD
Second Line :
City : PACIFICA
State : CA
Zip : 94044-4224
Country : US
Telephone Number : 650-355-1912
Fax Number :
Provider Business Practice Location Address
First Line : 1001 POTRERO AVE
Second Line : BLDG. 9, ROOM 115
City : SAN FRANCISCO
State : CA
Zip : 94110-3518
Country : US
Telephone Number : 415-206-2649
Fax Number : 415-206-6073
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2005
Last Update Date : 07/22/2015

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