1841464815 NPI number — MRS. ROSEMAE D'HAITI MITCHELL MS

Table of content: MRS. ROSEMAE D'HAITI MITCHELL MS (NPI 1841464815)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841464815 NPI number — MRS. ROSEMAE D'HAITI MITCHELL MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITCHELL
Provider First Name:
ROSEMAE
Provider Middle Name:
D'HAITI
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAVIS
Provider Other First Name:
ROSEMAE
Provider Other Middle Name:
D'HAITI
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841464815
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9600 VETERANS DR
Provider Second Line Business Mailing Address:
BUILDING 148
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98493-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-583-1634
Provider Business Mailing Address Fax Number:
253-589-4042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9600 VETERANS DR
Provider Second Line Business Practice Location Address:
BUILDING 148
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98493-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-583-1634
Provider Business Practice Location Address Fax Number:
253-589-4042
Provider Enumeration Date:
04/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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