Provider Demographics
NPI:1891596524
Name:WITTSTRUCK, HEATHER RENAE
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:RENAE
Last Name:WITTSTRUCK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6017 MERIDIAN DR APT 335
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-1072
Mailing Address - Country:US
Mailing Address - Phone:402-690-8774
Mailing Address - Fax:
Practice Address - Street 1:2911 N 5TH ST APT 3
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-2800
Practice Address - Country:US
Practice Address - Phone:402-690-8774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant