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Individual

CARLY WITHERELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
420 DELAWARE ST SE, MINNEAPOLIS, MN 55455-0341
(612) 884-0600
Mailing address
420 DELAWARE ST SE, MINNEAPOLIS, MN 55455-0341
(612) 624-8199

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MN

Other

Enumeration date
05/24/2020
Last updated
08/08/2023
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