Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 220 | FL |
NPI | 1033361969 |
---|---|
Provider Name | Mrs. Maria Virginia Wittebort |
First Address | Clermont, FL 34711-3632 |
Second Address | Clermont, FL 34711-3632 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2008 |
Last Update Date | 22/10/2008 |