Provider Demographics
NPI:1053771428
Name:PSYCHNURSE P.C.
Entity type:Organization
Organization Name:PSYCHNURSE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WITTCOFF
Authorized Official - Suffix:
Authorized Official - Credentials:CNS, MSN
Authorized Official - Phone:651-503-8800
Mailing Address - Street 1:5608 SANIBEL DR
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-4149
Mailing Address - Country:US
Mailing Address - Phone:952-935-0212
Mailing Address - Fax:
Practice Address - Street 1:3000 COUNTY ROAD 42 W
Practice Address - Street 2:SUITE 210
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4824
Practice Address - Country:US
Practice Address - Phone:952-898-7578
Practice Address - Fax:952-898-7592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty