Basic Information
| Provider Information | |||||||||
| NPI: | 1952691925 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WITT | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 920 E 1ST ST | ||||||||
| Address2: | STE. 302 | ||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558052201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2182496050 | ||||||||
| FaxNumber: | 2182496055 | ||||||||
| Practice Location | |||||||||
| Address1: | 920 E 1ST ST | ||||||||
| Address2: | STE. 302 | ||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558052201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2182496050 | ||||||||
| FaxNumber: | 2182496055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2011 | ||||||||
| LastUpdateDate: | 02/01/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 58498 | MN | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.