Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 282432 | NC |
NPI | 1003354390 |
---|---|
Provider Name | Erika Wittler |
First Address | Boston, MA 02298-6513 |
Second Address | Jacksonville, NC 28546-6328 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2017 |
Last Update Date | 03/12/2020 |