Provider Demographics
NPI:1033358650
Name:MITCHELL, BRANDIE A
Entity Type:Individual
Prefix:
First Name:BRANDIE
Middle Name:A
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 W 500 S
Mailing Address - Street 2:PO BOX 1908
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2914
Mailing Address - Country:US
Mailing Address - Phone:435-789-6300
Mailing Address - Fax:
Practice Address - Street 1:1140 W 500 S
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2914
Practice Address - Country:US
Practice Address - Phone:435-789-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT329882-3101164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse