Provider Demographics
NPI:1740951011
Name:MITZEL, MONICA JOY (DHN, CH)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:JOY
Last Name:MITZEL
Suffix:
Gender:F
Credentials:DHN, CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 EICHS RD
Mailing Address - Street 2:
Mailing Address - City:COCOLALLA
Mailing Address - State:ID
Mailing Address - Zip Code:83813-9525
Mailing Address - Country:US
Mailing Address - Phone:208-281-5667
Mailing Address - Fax:
Practice Address - Street 1:819 HIGHWAY 2 STE 207
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1678
Practice Address - Country:US
Practice Address - Phone:208-281-5667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-25
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education