Healthcare Provider Details

I. General information

NPI: 1720908049
Provider Name (Legal Business Name): MRS. TAMMY WITTENBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 OLD SEWARD HWY STE 300
ANCHORAGE AK
99503-6079
US

IV. Provider business mailing address

30680 DAREDEVIL CIR
SOLDOTNA AK
99669-8952
US

V. Phone/Fax

Practice location:
  • Phone: 920-770-0862
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number205417
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: