Provider Demographics
NPI:1194957019
Name:MITTLEIDER, ERICA F (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:F
Last Name:MITTLEIDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4508
Mailing Address - Country:US
Mailing Address - Phone:701-530-8800
Mailing Address - Fax:701-530-8750
Practice Address - Street 1:310 N 9TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4508
Practice Address - Country:US
Practice Address - Phone:701-530-8800
Practice Address - Fax:701-530-8750
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0416363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant