Provider Demographics
NPI:1912243734
Name:WITT, KATIE JO (CRNA)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:JO
Last Name:WITT
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Gender:F
Credentials:CRNA
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Mailing Address - Street 1:13911 RIDGEDALE DR
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1771
Mailing Address - Country:US
Mailing Address - Phone:952-932-9012
Mailing Address - Fax:952-932-7122
Practice Address - Street 1:13911 RIDGEDALE DR
Practice Address - Street 2:SUITE 350
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1771
Practice Address - Country:US
Practice Address - Phone:952-932-9012
Practice Address - Fax:952-932-7122
Is Sole Proprietor?:No
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
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Provider Licenses
StateLicense IDTaxonomies
MNR1465356367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered