Laura J Wittmann, FNP-BC
Individual provider Active NPI Family Nurse Practitioner · Shelby, MT
NPI 1295217289 · NPPES record last updated Apr 28, 2025
Key facts
- NPI
- 1295217289
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- NUR-APRN-LIC-161020 (MT)
- Practice address
- 640 Park Ave
Shelby, MT 59474-1663 - Phone
- (406) 434-3204
- NPI assigned
- Sep 5, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231212001529 | MT | Practitioner - Nurse Practitioner | 2466796537 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NUR-APRN-LIC-161020 | MT | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeast Alaska Regional Health Consortium | Current | Accepting new patients | |
| Southeast Alaska Regional Health Consortium | Current |
Accepting new patients | |
| Southeast Alaska Regional Health Consortium | Current |
Accepting new patients |
Locations
3100 Channel Dr
Ste 300
Juneau, AK 99801
Phone (907) 463-4000
222 Tongass Dr
Sitka, AK 99835
Phone (907) 966-8423
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 5010940 | NC | |
| Family Nurse Practitioner | 363LF0000X | NUR-APRN-LIC-161020 | MT | Yes |
Addresses
Primary practice location
640 Park Ave
Shelby, MT 59474-1663
Mailing address
1530 P B LN # W4973
Wichita Falls, TX 76302-2612
Phone (252) 571-2736
Other practice location 1
107 N Avenue A # 367
Knox City, TX 79529-9700
Phone (252) 571-2736
Other practice location 2
802 2nd St SE
Cut Bank, MT 59427-3329
Phone (406) 873-2251
Other practice location 3
805 Sunset Blvd
Conrad, MT 59425-1717
Phone (406) 271-3211
Other providers in Shelby, MT
- Deborah Elizabeth Treece
- Joni M Walton
- Ariel Joy Weishaar
- Dylan E Weishaar
- Jared Weishaar
- Lorena Wood
All providers in Shelby, MT · Family Nurse Practitioner in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 28, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.