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General NPI Number Information
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NPI Number | 1821475245
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Entity Type | Individual
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Provider Name | MARY D WITTE RN
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Gender | Female
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Dates
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Enumeration Date | 05/06/2015
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Last Update Date | 09/10/2020
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Provider Practice Location Address
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Address Line | 9436 SAINT MATHIAS RD
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City | BRAINERD
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State | MN
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Zip | 56401-5165
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Country | US
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Telephone | 218-855-1004
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Fax |
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Provider Business Mailing Address
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Address Line | 649KENILWORTH AVE
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City | DULUTH
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State | MN
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Zip | 55803
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Country | US
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Telephone | 218-820-6506
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R-103555-3
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License Number State | MN
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