Individual
RICHARD LEE MITTELSTEDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.N.
Contact information
Practice address
717 MISSION RD, FORT HALL, ID 83203-0717
(208) 238-5427
(208) 238-5427
Mailing address
717 MISSION ROAD, FORT HALL, ID 83203
(208) 238-5427
(208) 238-5427
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
N-32836
ID
Other
Enumeration date
12/21/2006
Last updated
07/08/2007
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