Healthcare Provider Details

I. General information

NPI: 1407831621
Provider Name (Legal Business Name): JUDITH ELIZABETH WITTE RN MN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NW 11TH ST SUITE E-37
HERMISTON OR
97838-8602
US

IV. Provider business mailing address

610 NW 11TH STREET
HERMISTON OR
97838
US

V. Phone/Fax

Practice location:
  • Phone: 541-667-3492
  • Fax: 541-667-3731
Mailing address:
  • Phone: 541-667-3732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number00025363
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: