Provider Demographics
NPI:1124436514
Name:MITZEL, LOUISE
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:
Last Name:MITZEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LOUISE
Other - Middle Name:
Other - Last Name:DEMARCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:423 6TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-2513
Mailing Address - Country:US
Mailing Address - Phone:701-662-8017
Mailing Address - Fax:
Practice Address - Street 1:423 6TH AVE NE
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-2513
Practice Address - Country:US
Practice Address - Phone:701-662-8017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator