Provider Demographics
NPI:1548299878
Name:MITZEL, HEATHER M (CNP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:MITZEL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 S CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-3245
Mailing Address - Country:US
Mailing Address - Phone:605-274-6300
Mailing Address - Fax:605-333-4875
Practice Address - Street 1:1727 S CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-3245
Practice Address - Country:US
Practice Address - Phone:605-274-6300
Practice Address - Fax:605-333-4875
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000384363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDP00470907OtherRAILROAD MEDICARE
IA30969OtherBCBS
MN694635000Medicaid
SD6822952Medicaid
IA0746743Medicaid
SD4993420OtherBCBS
SDS101469Medicare PIN
SD6822952Medicaid