Healthcare Provider Details

I. General information

NPI: 1134635923
Provider Name (Legal Business Name): MATTHEW WARREN WITTMANN RP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 N 27TH ST
LINCOLN NE
68521-1194
US

IV. Provider business mailing address

4900 N 27TH ST
LINCOLN NE
68521-1194
US

V. Phone/Fax

Practice location:
  • Phone: 402-438-3015
  • Fax: 402-438-3132
Mailing address:
  • Phone: 402-438-3015
  • Fax: 402-438-3132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9547
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: