Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | 1111715 | KY |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 1111715 | KY |
NPI | 1841673753 |
---|---|
Provider Name | Shannon Witt |
First Address | Georgetown, IN 47122-8785 |
Second Address | New Albany, IN 47150-5100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2015 |
Last Update Date | 29/05/2019 |