Healthcare Provider Details

I. General information

NPI: 1558878363
Provider Name (Legal Business Name): NICOLE ANN WITOWSKI APRN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2018
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 S 7TH ST
MINNEAPOLIS MN
55454-1404
US

IV. Provider business mailing address

5765 FEATHERIE BAY
SHOREWOOD MN
55331-4102
US

V. Phone/Fax

Practice location:
  • Phone: 612-365-6777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5689
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1786022
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: