Healthcare Provider Details

I. General information

NPI: 1922534536
Provider Name (Legal Business Name): CASSANDRA WITTNER CST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 EXCHANGE ST W STE 622
SAINT PAUL MN
55102-1225
US

IV. Provider business mailing address

17 EXCHANGE ST W STE 622
SAINT PAUL MN
55102-1225
US

V. Phone/Fax

Practice location:
  • Phone: 651-227-9141
  • Fax: 651-265-6772
Mailing address:
  • Phone: 651-227-9141
  • Fax: 651-265-6772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberAB791878-HCP
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: