Healthcare Provider Details

I. General information

NPI: 1518550151
Provider Name (Legal Business Name): SHARON A WITTENBREDER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2021
Last Update Date: 03/17/2022
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 CHERRY ST
SCRANTON PA
18505-1505
US

IV. Provider business mailing address

501 S WASHINGTON AVE STE 1000
SCRANTON PA
18505-3814
US

V. Phone/Fax

Practice location:
  • Phone: 570-591-5250
  • Fax:
Mailing address:
  • Phone: 570-343-2383
  • Fax: 570-343-3923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP023415
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP023415
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN530044L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: