Active NPI
Mary D Witte, RN
- Registered Nurse
- Brainerd, MN
National Provider Identifier
1821475245
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- R-103555-3
- Practice address
- 9436 Saint Mathias Rd
Brainerd, MN 56401-5165 - Phone
- (218) 855-1004
- NPI assigned
- May 6, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | R-103555-3 | MN | Primary |
Addresses
Primary practice location
9436 Saint Mathias Rd
Brainerd, MN 56401-5165
Mailing address
649Kenilworth Ave
Duluth, MN 55803
Phone (218) 820-6506
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 129-RN | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R-103555-3 | MN | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1430870400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599696000000",
"number": "1821475245",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "649KENILWORTH AVE",
"city": "DULUTH",
"state": "MN",
"postal_code": "55803",
"telephone_number": "218-820-6506"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9436 SAINT MATHIAS RD",
"city": "BRAINERD",
"state": "MN",
"postal_code": "564015165",
"telephone_number": "218-855-1004"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WITTE",
"first_name": "MARY",
"middle_name": "D",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-05-06",
"last_updated": "2020-09-10",
"certification_date": "2020-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MN",
"license": "R-103555-3",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "129-RN",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brainerd, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.