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General NPI Number Information
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NPI Number | 1801639596
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Entity Type | Individual
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Provider Name | ZACHARY JOESPH WITGES AGNP
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Gender | Male
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Dates
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Enumeration Date | 06/18/2024
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 4 MEMORIAL DR STE 230
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City | ALTON
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State | IL
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Zip | 62002-6704
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Country | US
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Telephone | 618-463-7874
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Fax | 314-996-7658
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Provider Business Mailing Address
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Address Line | PO BOX 959203
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City | SAINT LOUIS
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State | MO
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Zip | 63195-8512
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Country | US
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Telephone | 618-234-2390
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Fax | 314-996-7658
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 209.029825
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209029825
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2024043178
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License Number State | MO
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