Provider Demographics
NPI:1184643967
Name:MITCHELL, ALISIA A (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ALISIA
Middle Name:A
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ALISIA
Other - Middle Name:M
Other - Last Name:OLIVITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 POLARIS PKWY
Mailing Address - Street 2:STE 2350
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7989
Mailing Address - Country:US
Mailing Address - Phone:614-566-9777
Mailing Address - Fax:614-566-8611
Practice Address - Street 1:5400 FRANTZ RD
Practice Address - Street 2:STE 250
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-4144
Practice Address - Country:US
Practice Address - Phone:614-544-6366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN245816163W00000X
OHNP05859363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000485282OtherANTHEM PIN
OH2267925Medicaid
OHNP08443Medicare PIN
OH000000485282OtherANTHEM PIN
OHP36715Medicare UPIN
OHNP08444Medicare PIN