Provider Demographics
NPI:1154673358
Name:MITSCHELEN, TERI GAYLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:TERI
Middle Name:GAYLE
Last Name:MITSCHELEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 220
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:WA
Mailing Address - Zip Code:98812
Mailing Address - Country:US
Mailing Address - Phone:509-689-4000
Mailing Address - Fax:509-689-3906
Practice Address - Street 1:520 W. INDIAN AVE
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:WA
Practice Address - Zip Code:98812
Practice Address - Country:US
Practice Address - Phone:509-689-4000
Practice Address - Fax:509-689-3906
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00106951163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant