Individual provider Active NPI

Shyla Michelle Witthaus, FNP-BC

  • Family Nurse Practitioner
  • Yorba Linda, CA
National Provider Identifier
1144684499
Registry record updated Apr 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209.011227 Issued in IL
Practice address
18300 Yorba Linda Blvd
Yorba Linda, CA 92886
Phone
(714) 577-6000
NPI assigned
Apr 12, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 041.384423 IL
Family Nurse Practitioner 363LF0000X 209.011227 IL Primary

Addresses

Primary practice location

18300 Yorba Linda Blvd
Yorba Linda, CA 92886

Mailing address

39924 N Trevino LN
Antioch, IL 60002-2320
Phone (210) 326-0477

Other practice location 1

201 S Milwaukee Ave
Lake Villa, IL 60046-8551
Phone (847) 356-9009

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address switthaus1156629@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Apr 1, 2026 through Apr 1, 2028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
041.384423ILMDRegistered Nurse
209.011227ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Yorba Linda Family Physicians, a Medical Group, Inc. Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: switthaus1156629@oc.providencedirect.org

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1460419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618876800000",
    "number": "1144684499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39924 N TREVINO LN",
            "city": "ANTIOCH",
            "state": "IL",
            "postal_code": "600022320",
            "telephone_number": "210-326-0477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18300 YORBA LINDA BLVD",
            "city": "YORBA LINDA",
            "state": "CA",
            "postal_code": "92886",
            "telephone_number": "714-577-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "201 S Milwaukee Ave",
            "address_purpose": "LOCATION",
            "city": "Lake Villa",
            "state": "IL",
            "postal_code": "600468551",
            "country_code": "US",
            "telephone_number": "847-356-9009",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WITTHAUS",
        "first_name": "SHYLA",
        "middle_name": "MICHELLE",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-12",
        "last_updated": "2021-04-20",
        "certification_date": "2021-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041.384423",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.011227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "switthaus1156629@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1826 W Orangethorpe Ave",
            "city": "Fullerton",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928334406",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Yorba Linda, CA

Sources for this page

Verify at the official NPI Registry.