Doctor Name: | CHARLOTTE C DEWITT |
NPI Number: | 1104106509 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 2011027097 |
Business Practice Address: | 135 Plaza Dr Suite 102 Sikeston, MO - 638015136 |
Business Phone Number: | 5734726010 |
Business Fax Number: | 5734726009 |
Mailing Address: | 135 Plaza Dr, Suite 102 SIKESTON |
State: | MO |
Postal Code: | 638015136 |
Phone Number: | 5734726010 |
Fax Number: | 5734726009 |
NPI Enumeration Date: | 08/17/2011 |
NPI Last Update Date: | 07/28/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 2011027097 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |