1538264312 NPI number — NANCY P MITCHELL N.P.

Table of content: NANCY P MITCHELL N.P. (NPI 1538264312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538264312 NPI number — NANCY P MITCHELL N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITCHELL
Provider First Name:
NANCY
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
N.P.
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:
1538264312
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:
100 FLAXWOOD LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINOA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13116-1006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-656-2169
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 PRESIDENTIAL PLZ FL 3
Provider Second Line Business Practice Location Address:
UNIVERSITY PEDIATRIC AND ADOLESCENT CENTER
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13202-2240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-464-2273
Provider Business Practice Location Address Fax Number:
315-464-2048
Provider Enumeration Date:
09/14/2006

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: 363LP0200X , with the licence number:  F380032-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01967211 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com