Basic Information
| Provider Information | |||||||||
| NPI: | 1316979198 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WITTCOFF | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | RN, CNS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3000 COUNTY ROAD 42 W | ||||||||
| Address2: | STE 210 | ||||||||
| City: | BURNSVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553374826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123472218 | ||||||||
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| Practice Location | |||||||||
| Address1: | 914 S 8TH ST | ||||||||
| Address2: | S100 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554041210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123472218 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 03/15/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0808X | R 140300-4 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health |
No ID Information.