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NPI Code Detail

MEDICARE: STEPHANIE JO WITTMAN

MEDICARE:   STEPHANIE JO WITTMAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer700-15ND

General Provider Information

NPI Number : 1417552910
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE JO WITTMAN
Provider Business Mailing Address
First Line : 1300 17TH AVE NORTH
Second Line :
City : FARGO
State : ND
Zip : 58102
Country : US
Telephone Number : 701-730-6260
Fax Number :
Provider Business Practice Location Address
First Line : 1300 17TH AVE NORTH
Second Line :
City : FARGO
State : ND
Zip : 58102-5810
Country : US
Telephone Number : 701-730-6260
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2020
Last Update Date : 12/02/2020

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Directions to “ STEPHANIE JO WITTMAN ” Practice Location

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