Healthcare Provider Details

I. General information

NPI: 1366089757
Provider Name (Legal Business Name): KATHERINE MITZEL MS, APRN, A-GNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 ENTERPRISE DR
WILMINGTON NC
28405-2116
US

IV. Provider business mailing address

116 WETLAND DR
WILMINGTON NC
28412-2726
US

V. Phone/Fax

Practice location:
  • Phone: 910-791-3451
  • Fax:
Mailing address:
  • Phone: 910-547-8937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN228377
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5019728
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: