Healthcare Provider Details

I. General information

NPI: 1740951011
Provider Name (Legal Business Name): MONICA JOY MITZEL DHN, CH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2021
Last Update Date: 09/11/2025
Certification Date: 09/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 HIGHWAY 2 STE 207
SANDPOINT ID
83864-1678
US

IV. Provider business mailing address

45 EICHS RD
COCOLALLA ID
83813-9525
US

V. Phone/Fax

Practice location:
  • Phone: 208-281-5667
  • Fax:
Mailing address:
  • Phone: 208-281-5667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: