Individual
GWEN WITZEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
5225 23RD AVE S, FARGO, ND 58104-7927
(701) 234-2000
Mailing address
PO BOX 2010, FARGO, ND 58122-2484
(701) 234-2000
(701) 417-3726
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R22146
ND
363LF0000X
Family Nurse Practitioner
R22146
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19584
—
ND
Enumeration date
06/03/2006
Last updated
04/05/2018
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