Provider Demographics
NPI:1073616090
Name:MITCHELL, PAUL E (CNP)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 SHAY RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:NY
Mailing Address - Zip Code:14512-9607
Mailing Address - Country:US
Mailing Address - Phone:585-554-3004
Mailing Address - Fax:315-536-4107
Practice Address - Street 1:1930 PRE EMPTION RD
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-9641
Practice Address - Country:US
Practice Address - Phone:315-536-0086
Practice Address - Fax:315-536-4107
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330472363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
109491BFOtherPREFERRED CARE
P019330472OtherBLUE CHOICE
NYR55059Medicare UPIN
DD1507Medicare ID - Type Unspecified