Provider Demographics
NPI:1962771717
Name:DENISE S. WITTLIN-HORVATH PSYCHIATRIC NURSE PRACTITIONER, PLLC
Entity type:Organization
Organization Name:DENISE S. WITTLIN-HORVATH PSYCHIATRIC NURSE PRACTITIONER, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:S
Authorized Official - Last Name:WITTLIN-HORVATH
Authorized Official - Suffix:
Authorized Official - Credentials:NPP
Authorized Official - Phone:607-256-1167
Mailing Address - Street 1:108 S ALBANY ST
Mailing Address - Street 2:STE 1A
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5446
Mailing Address - Country:US
Mailing Address - Phone:607-256-1167
Mailing Address - Fax:
Practice Address - Street 1:108 S ALBANY ST
Practice Address - Street 2:STE 1A
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5446
Practice Address - Country:US
Practice Address - Phone:607-256-1167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401117-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty