Provider Demographics
NPI:1154308054
Name:WIITA, SANDRA
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:WIITA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4538 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-3621
Mailing Address - Country:US
Mailing Address - Phone:952-412-4847
Mailing Address - Fax:
Practice Address - Street 1:4538 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-3621
Practice Address - Country:US
Practice Address - Phone:952-412-4847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51980-20207Q00000X
IN01072488A207Q00000X
TXP9989207Q00000X
OK29912207Q00000X
OH35.122172207Q00000X
NY268105-1207Q00000X
NMMD2013-0891207Q00000X
NE27356207Q00000X
MI4301102453207Q00000X
LAMD.206767207Q00000X
IL036.131953207Q00000X
CT051623207Q00000X
MO2013011071207Q00000X
MN42376207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine