| Doctor Name: | MITCHELL R WOLDT |
| NPI Number: | 1215276407 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | FNP |
| License Number: | F0113179 |
| Business Practice Address: | 1750 Robert St S West St Paul, MN - 551183919 |
| Business Phone Number: | 6514556671 |
| Business Fax Number: | |
| Mailing Address: | 1750 Robert St S, WEST ST PAUL |
| State: | MN |
| Postal Code: | 551183919 |
| Phone Number: | 6514556671 |
| Fax Number: | |
| NPI Enumeration Date: | 02/07/2013 |
| NPI Last Update Date: | 04/11/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | F0113179 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |