Provider Demographics
NPI:1821155375
Name:WITT, JAMIE (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:WITT
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:4225 GOLDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4215
Mailing Address - Country:US
Mailing Address - Phone:763-588-0661
Mailing Address - Fax:763-302-4345
Practice Address - Street 1:9645 GROVE CIR N STE 100
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4466
Practice Address - Country:US
Practice Address - Phone:763-302-4114
Practice Address - Fax:763-302-4081
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2022-05-19
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Provider Licenses
StateLicense IDTaxonomies
MN9955363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN970006243Medicare PIN