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NPI Code Detail

MEDICARE: LAUREL WITTE DO

MEDICARE: LAUREL WITTE DO
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
1208100000XPhysical Medicine & Rehabilitation PhysicianSL2575NV
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1417715996
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAUREL WITTE DO
Provider Business Mailing Address
First Line : 3100 N TENAYA WAY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-0436
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3100 N TENAYA WAY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-0436
Country : US
Telephone Number : 702-217-6709
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2024
Last Update Date : 06/12/2026

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Directions to “ LAUREL WITTE DO” Practice Location

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