Provider Demographics
NPI:1730819657
Name:WITKOWSKI, FAYE MARION
Entity type:Individual
Prefix:
First Name:FAYE
Middle Name:MARION
Last Name:WITKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 CHAMBERLAIN ST.
Mailing Address - Street 2:CLOCKTOWER PLACE, APT #202
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014
Mailing Address - Country:US
Mailing Address - Phone:847-507-1044
Mailing Address - Fax:
Practice Address - Street 1:534 WALLACE RD
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50011-4008
Practice Address - Country:US
Practice Address - Phone:515-294-8718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program