Gaylene P Witucki
Individual provider Active NPI In Home Supportive Care Agency · Royalton, MN
NPI 1013624766 · NPPES record last updated Nov 2, 2022
Key facts
- NPI
- 1013624766
- Entity type
- Individual (NPI type 1)
- Primary specialty
- In Home Supportive Care Agency 253Z00000X
- License
- 1114599 (MN)
- Practice address
- 512 E Centre St
Royalton, MN 56373-9100 - Phone
- (320) 223-5530
- NPI assigned
- Nov 2, 2022
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1114599 | MN | MD | In Home Supportive Care Agency |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| In Home Supportive Care Agency | 253Z00000X | 1114599 | MN | Yes |
Addresses
Primary practice location
512 E Centre St
Royalton, MN 56373-9100
Mailing address
512 E Centre St
Royalton, MN 56373-9100
Phone (320) 223-5530
Other providers in Royalton, MN
All providers in Royalton, MN · In Home Supportive Care Agency in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 2, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.