Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 4704219556 | MI |
NPI | 1053960807 |
---|---|
Provider Name | Julia Ann Witte |
First Address | Spring Lake, MI 49456-8846 |
Second Address | Grand Haven, MI 49417-2795 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2019 |
Last Update Date | 04/09/2019 |