MEDICARE: CHERON L. WITTMAN PA-C

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
1	363A00000X	Physician Assistant	PA10003918	WA

General Provider Information

NPI Number	:	1427087378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERON L. WITTMAN PA-C

Provider Business Mailing Address
First Line	:	10004 204TH AVE E
Second Line	:	STE 2200
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-6539
Country	:	US
Telephone Number	:	253-447-3300
Fax Number	:

Provider Business Practice Location Address
First Line	:	10004 204TH AVE E
Second Line	:	STE 2200
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-6539
Country	:	US
Telephone Number	:	253-447-3300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	11/07/2013

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