Provider Demographics
NPI:1538727060
Name:WITTEKIND, CHAD DOUGLAS (FNP-BC)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:DOUGLAS
Last Name:WITTEKIND
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 CLOVERVIEW ST
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-6052
Mailing Address - Country:US
Mailing Address - Phone:740-525-8403
Mailing Address - Fax:
Practice Address - Street 1:1251 CLOVERVIEW ST
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-6052
Practice Address - Country:US
Practice Address - Phone:740-525-8403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024755363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily