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Individual
WYATT L MITZEL
Active
Individual
WYATT L MITZEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PAC0269
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0113521
MEDICA #
ND
01
—
0113522
MEDICA #
ND
05
—
084985500
—
ND
01
—
1783342
AMERICA'S PPO/ARAZ #
ND
01
—
21288
NDBS #
ND
01
—
49G81MI
MNBS #
ND
01
—
DA9011029348
PREFERRED ONE #
ND
01
—
HP38584
HEALTHPARTNERS #
ND
Enumeration date
07/11/2006
Last updated
01/09/2025
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