MEDICARE: MONICA JOY MITZEL DHN, CH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133NN1002X	Nutrition Education Nutritionist

General Provider Information

NPI Number	:	1740951011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA JOY MITZEL DHN, CH

Provider Business Mailing Address
First Line	:	45 EICHS RD
Second Line	:
City	:	COCOLALLA
State	:	ID
Zip	:	83813-9525
Country	:	US
Telephone Number	:	208-281-5667
Fax Number	:

Provider Business Practice Location Address
First Line	:	819 HIGHWAY 2 STE 207
Second Line	:
City	:	SANDPOINT
State	:	ID
Zip	:	83864-1678
Country	:	US
Telephone Number	:	208-281-5667
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2021
Last Update Date	:	09/11/2025

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