Individual
MARY D WITTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
9436 SAINT MATHIAS RD, BRAINERD, MN 56401-5165
(218) 855-1004
Mailing address
649KENILWORTH AVE, DULUTH, MN 55803
(218) 820-6506
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R-103555-3
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
129-RN
—
MN
Enumeration date
05/06/2015
Last updated
09/10/2020
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