Individual
KELLY WITUCKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1575 BEAM AVE, MAPLEWOOD, MN 55109-1126
(651) 232-7348
Mailing address
2829 UNIVERSITY AVE SE STE 730, MINNEAPOLIS, MN 55414-3279
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
15652
MN
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
09/06/2025
Last updated
01/22/2026
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