1255383980 NPI number — MRS. HEATHER MARIE MITCHELL MSW

Table of content: MRS. HEATHER MARIE MITCHELL MSW (NPI 1255383980)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255383980 NPI number — MRS. HEATHER MARIE MITCHELL MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITCHELL
Provider First Name:
HEATHER
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
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:
1255383980
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:
13 SILVERKING CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PERRYVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21903-2420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-642-2411
Provider Business Mailing Address Fax Number:
410-642-1710

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PERRY POINT VA MEDICAL CENTER
Provider Second Line Business Practice Location Address:
23B
Provider Business Practice Location Address City Name:
PERRY POINT
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-642-2411
Provider Business Practice Location Address Fax Number:
140-642-1710
Provider Enumeration Date:
05/17/2006

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: 1041C0700X , with the licence number:  Q1-0000834 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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