# WYATT L MITZEL

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1770518599
- **Gender:** Man
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | PAC0269 | ND | Yes |

## Other

- **Enumeration date:** 07/11/2006
- **Last updated:** 01/09/2025

## 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 |