Provider Demographics
NPI:1366089757
Name:MITZEL, KATHERINE (MS, APRN, A-GNP-C)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:MITZEL
Suffix:
Gender:F
Credentials:MS, APRN, A-GNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 WETLAND DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2726
Mailing Address - Country:US
Mailing Address - Phone:910-547-8937
Mailing Address - Fax:
Practice Address - Street 1:3015 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-2116
Practice Address - Country:US
Practice Address - Phone:910-791-3451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-04
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN228377363L00000X
NC5019728363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner