Healthcare Provider Details

I. General information

NPI: 1861239642
Provider Name (Legal Business Name): MELISSA WITT BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/10/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 WOOLWORTH AVE
OMAHA NE
68105-1850
US

IV. Provider business mailing address

21 BONNEVILLE LN
COUNCIL BLUFFS IA
51503-7706
US

V. Phone/Fax

Practice location:
  • Phone: 402-346-8800
  • Fax:
Mailing address:
  • Phone: 712-314-7814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number134702
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: