Healthcare Provider Details

I. General information

NPI: 1568160877
Provider Name (Legal Business Name): DEBORAH MARIE WITTENBORN DNP, AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 NORTHLINE AVE STE 250
GREENSBORO NC
27408-7619
US

IV. Provider business mailing address

3200 NORTHLINE AVE STE 250
GREENSBORO NC
27408-7619
US

V. Phone/Fax

Practice location:
  • Phone: 336-273-7900
  • Fax:
Mailing address:
  • Phone: 362-737-9003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5018216
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number263193
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: