Healthcare Provider Details

I. General information

NPI: 1962390104
Provider Name (Legal Business Name): JAMES DAVID WITTER III RN, BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S 48TH ST
LINCOLN NE
68506-1283
US

IV. Provider business mailing address

1910 SW 33RD ST
LINCOLN NE
68522-9181
US

V. Phone/Fax

Practice location:
  • Phone: 402-481-1111
  • Fax:
Mailing address:
  • Phone: 402-367-9842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number91137
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: