Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 33820 | AZ |
NPI | 1255407854 |
---|---|
Provider Name | Ms. Brenda J Wittman |
First Address | Portland, OR 97208-4105 |
Second Address | Anchorage, AK 99508-4691 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2006 |
Last Update Date | 15/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
936073 | (05) | AZ |
I28958 | (02) |