Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mio Watanabe, PA-C

Individual provider Physician Assistant · NPI 1730695412

Mio Watanabe, PA-C is a Physician Assistant in Grand Forks, North Dakota. Qualified in 2017, 9 years ago. Practices with Peterson Medical Clinics LLC, a 89-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in Alaska, Minnesota, North Dakota and Utah.

Years since qualifying
9
Licensed in
AK, MN, ND, UT
In the registry since
2017
Specialties on file
4
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

3674 S Washington St
Grand Forks, ND 58201-5766
Phone: (701) 205-3000
Fax: (701) 732-2501
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 672 W 400 S # B201, Springville, UT 84663-3157 — (801) 369-8989

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PAC0794 (ND)
Physician Assistant Taxonomy 363A00000X · Licence 105968801206 (UT)
Physician Assistant Taxonomy 363A00000X · Licence 13106 (MN)
Physician Assistant Taxonomy 363A00000X · Licence 141585 (AK)

Record details

NPI number1730695412
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedDecember 18, 2017
Last updated in NPPESJanuary 21, 2026
Certification dateJanuary 21, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Peterson Medical Clinics Llc — 89 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations4 on file with Medicare

Other providers in Grand Forks