Individual
KRYSTAL A MITICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1821 S WEBSTER AVE, GREEN BAY, WI 54301-2253
(920) 496-4700
Mailing address
1821 S WEBSTER AVE, GREEN BAY, WI 54301-2253
(920) 496-4700
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4248-23
WI
Other
Enumeration date
07/20/2016
Last updated
02/10/2023
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