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General NPI Number Information
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NPI Number | 1316313406
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Entity Type | Organization
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Legal Business Name | WITEK ENTERPRISES INC
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Dates
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Enumeration Date | 08/12/2015
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Last Update Date | 08/12/2015
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Provider Practice Location Address
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Address Line | 13204 LAVENIA LN
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City | LOUISVILLE
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State | KY
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Zip | 40272-6130
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Country | US
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Telephone | 502-494-1066
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Fax | 502-290-3434
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Provider Business Mailing Address
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Address Line | 13204 LAVENIA LN
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City | LOUISVILLE
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State | KY
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Zip | 40272-6130
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Country | US
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Telephone | 502-494-1066
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Fax | 502-290-3434
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. PAMELA WITEK
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Credential | APRN
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Telephone | 502-494-1066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3007685
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License Number State | KY
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