Active NPI
Heather C Wittmann, PA-C
- Medical Physician Assistant
- Lebanon, NH
National Provider Identifier
1790718070
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 0301
- Practice address
- 1 Medical Center Dr
Lebanon, NH 03756-1000 - Phone
- (603) 653-9500
- NPI assigned
- Jul 9, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 0301 | NH | Primary |
| Medical Physician Assistant | 363AM0700X | 055-0030388 | VT |
Addresses
Primary practice location
1 Medical Center Dr
Lebanon, NH 03756-1000
Mailing address
1 Medical Center Dr
DHMC- Gim
Lebanon, NH 03756-1000
Phone (603) 653-9500
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30011103 | Medicaid | NH | |
| 0301 | Other | NH | LICENSE |
| 055-0030388 | Other | VT | LICENSE |
| 2002091 | Medicaid | VT |
Other names 1
- Heather Clarke
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0301 | NH | MD | Podiatrist |
| 055-0030388 | VT | MD | Medical Physician Assistant |
| 055-0030766 | VT | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152403200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1790718070",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 MEDICAL CENTER DR",
"address_2": "DHMC- GIM",
"city": "LEBANON",
"state": "NH",
"postal_code": "037561000",
"telephone_number": "603-653-9500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 MEDICAL CENTER DR",
"city": "LEBANON",
"state": "NH",
"postal_code": "037561000",
"telephone_number": "603-653-9500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WITTMANN",
"first_name": "HEATHER",
"middle_name": "C",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-09",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "NH",
"license": "0301",
"primary": true
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "VT",
"license": "055-0030388",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30011103",
"state": "NH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "0301",
"state": "NH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "055-0030388",
"state": "VT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2002091",
"state": "VT"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "HEATHER",
"last_name": "CLARKE",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Lebanon, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.