1215551601 NPI number — KAITLYN WITTWER CNM

Table of content: KAITLYN WITTWER CNM (NPI 1215551601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215551601 NPI number — KAITLYN WITTWER CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WITTWER
Provider First Name:
KAITLYN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALBACH
Provider Other First Name:
KAITLYN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CNM
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215551601
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1537 W STONE GATE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARATOGA SPRINGS
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84045-5314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-615-3009
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1886 W 800 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLEASANT GROVE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84062-4097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-756-5288
Provider Business Practice Location Address Fax Number:
801-418-0941
Provider Enumeration Date:
06/02/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WX0003X , with the licence number:  7353557-3102 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367A00000X , with the licence number: 7353557-4402 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)