Provider Demographics
NPI:1902983687
Name:BITTNER, DENISE KIM (CRNP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:KIM
Last Name:BITTNER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2827
Mailing Address - Country:US
Mailing Address - Phone:301-777-8383
Mailing Address - Fax:301-777-2780
Practice Address - Street 1:224 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2827
Practice Address - Country:US
Practice Address - Phone:301-777-8383
Practice Address - Fax:301-777-2780
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR089384363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQ27180Medicare UPIN
MD173L J797Medicare ID - Type Unspecified