Active NPI
Laura Wittmann, MD
- Psychiatry Physician
- Tacoma, WA
National Provider Identifier
1265964084
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- MD60972141
- Practice address
- 621 Pacific Ave Ste 209
Tacoma, WA 98402-4619 - Phone
- (253) 275-5467
- NPI assigned
- Mar 30, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Psychiatry Physician | 2084P0800X | MD60972141 | WA | Primary |
Addresses
Primary practice location
621 Pacific Ave Ste 209
Tacoma, WA 98402-4619
Mailing address
1959 NE Pacific St
Box 356560
Seattle, WA 98195-6560
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Dec 8, 2021 through Dec 8, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD60972141 | WA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490832000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651795200000",
"number": "1265964084",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1959 NE PACIFIC ST",
"address_2": "BOX 356560",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981956560"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "621 PACIFIC AVE STE 209",
"city": "TACOMA",
"state": "WA",
"postal_code": "984024619",
"telephone_number": "253-275-5467"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WITTMANN",
"first_name": "LAURA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-03-30",
"last_updated": "2022-05-06",
"certification_date": "2022-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "WA",
"license": "MD60972141",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.