1245218379 NPI number — TAMI LYNN MITCHELL RN, NP

Table of content: TAMI LYNN MITCHELL RN, NP (NPI 1245218379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245218379 NPI number — TAMI LYNN MITCHELL RN, NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITCHELL
Provider First Name:
TAMI
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245218379
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9215 S CLAREMONT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOWLER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93625-9637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-834-6766
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 N VALERIA ST
Provider Second Line Business Practice Location Address:
SSUITE 406
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93701-2166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-486-8888
Provider Business Practice Location Address Fax Number:
559-426-8887
Provider Enumeration Date:
01/09/2006

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: 363LW0102X , with the licence number:  7204 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 41140 . This is a "REGISTERED NURSE LIC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 7204 . This is a "NURSE PRACTITIONER LIC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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