Provider Demographics
NPI:1962780429
Name:WITMER, JESSICA S (FNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:S
Last Name:WITMER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ORRVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44667-2291
Mailing Address - Country:US
Mailing Address - Phone:330-684-2015
Mailing Address - Fax:330-684-2075
Practice Address - Street 1:830 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ORRVILLE
Practice Address - State:OH
Practice Address - Zip Code:44667-2291
Practice Address - Country:US
Practice Address - Phone:330-684-2015
Practice Address - Fax:330-684-2075
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12479363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH12479-NPOtherCOA