Provider Demographics
NPI:1053505495
Name:WITT, DIANE E (NP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:E
Last Name:WITT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4784 390TH AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56048-1701
Mailing Address - Country:US
Mailing Address - Phone:507-234-6906
Mailing Address - Fax:507-234-6906
Practice Address - Street 1:4784 390TH AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:MN
Practice Address - Zip Code:56048-1701
Practice Address - Country:US
Practice Address - Phone:507-234-6906
Practice Address - Fax:507-234-6906
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP 0951363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health