Provider Demographics
NPI:1013595503
Name:MITCHELL, ROSALIE DELANEY (LM, CPM)
Entity Type:Individual
Prefix:MS
First Name:ROSALIE
Middle Name:DELANEY
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 EVERGREEN AVE SW
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-4421
Mailing Address - Country:US
Mailing Address - Phone:386-466-8404
Mailing Address - Fax:800-853-5087
Practice Address - Street 1:2010 EVERGREEN AVE SW
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-4421
Practice Address - Country:US
Practice Address - Phone:386-466-8404
Practice Address - Fax:800-853-5087
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW404176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMW404OtherSTATE LICENSE NUMBER