Healthcare Provider Details

I. General information

NPI: 1992669915
Provider Name (Legal Business Name): LESIA WITKOWSKY PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2025
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5914 PROSPERITY DR
ANCHORAGE AK
99504-3264
US

IV. Provider business mailing address

5914 PROSPERITY DR
ANCHORAGE AK
99504-3264
US

V. Phone/Fax

Practice location:
  • Phone: 847-630-8533
  • Fax:
Mailing address:
  • Phone: 847-630-8533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number234356
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: