Provider Demographics
NPI:1033652714
Name:MITCHELL, STEPHANIE MARISA (CNM)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MARISA
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:720 HARRISON AVE # DOB503
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2371
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:850 HARRISON AVE # YACC5
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-4001
Practice Address - Country:US
Practice Address - Phone:617-414-2000
Practice Address - Fax:617-414-5798
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RICNM00162367A00000X
MARN276763367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife