Healthcare Provider Details

I. General information

NPI: 1831712439
Provider Name (Legal Business Name): ANNA DITTMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 SMITH AVE N
SAINT PAUL MN
55102-2344
US

IV. Provider business mailing address

3922 PAUNACK AVE
MADISON WI
53711-1623
US

V. Phone/Fax

Practice location:
  • Phone: 651-241-8000
  • Fax:
Mailing address:
  • Phone: 608-556-1496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number2481741
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2487
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: