=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982045514
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHLEY A. WITTLER NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2013
-----------------------------------------------------
Last Update Date | 08/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1170 FORTUNE BLVD
-----------------------------------------------------
City | SHILOH
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62269-7358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-997-5266
-----------------------------------------------------
Fax | 883-431-2272
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1170 FORTUNE BLVD
-----------------------------------------------------
City | SHILOH
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62269-7358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-997-5266
-----------------------------------------------------
Fax | 883-431-2272
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LX0001X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
-----------------------------------------------------
License Number | 209010684
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number | 209010684
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------