Provider Demographics
NPI:1215573811
Name:MITCHELL, SYTRISS LASEAN (LPN)
Entity Type:Individual
Prefix:
First Name:SYTRISS
Middle Name:LASEAN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33006 7 MILE RD STE 412
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1358
Mailing Address - Country:US
Mailing Address - Phone:734-223-0520
Mailing Address - Fax:734-345-4378
Practice Address - Street 1:1638 EAST LAKEVIEW LANE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187
Practice Address - Country:US
Practice Address - Phone:734-223-0520
Practice Address - Fax:734-345-4378
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703118271164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse