Individual
MIO WATANABE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3674 S WASHINGTON ST, GRAND FORKS, ND 58201-5766
(701) 205-3000
(701) 732-2501
Mailing address
PO BOX 5210, GRAND FORKS, ND 58206-5210
(701) 205-3000
(701) 732-2501
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
105968801206
UT
363A00000X
Physician Assistant
13106
MN
363A00000X
Physician Assistant
141585
AK
363A00000X
Physician Assistant
Primary
PAC0794
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1478025
—
ND
05
—
1693549
—
AK
05
—
1730695412
—
MN
Enumeration date
12/18/2017
Last updated
01/21/2026
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