| Doctor Name: | DIANE E WITT |
| NPI Number: | 1053505495 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | N.P. |
| License Number: | CNP 0951 |
| Business Practice Address: | 4784 390th Ave Janesville, MN - 560481701 |
| Business Phone Number: | 5072346906 |
| Business Fax Number: | 5072346906 |
| Mailing Address: | 4784 390th Ave, JANESVILLE |
| State: | MN |
| Postal Code: | 560481701 |
| Phone Number: | 5072346906 |
| Fax Number: | 5072346906 |
| NPI Enumeration Date: | 08/29/2007 |
| NPI Last Update Date: | 09/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | CNP 0951 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |