Provider Demographics
NPI:1225044233
Name:MITCH, ROBERTA LEE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:LEE
Last Name:MITCH
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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Mailing Address - Street 1:1654 UPHAM DR
Mailing Address - Street 2:MEANS HALL, 522
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1250
Mailing Address - Country:US
Mailing Address - Phone:614-293-9269
Mailing Address - Fax:614-293-5877
Practice Address - Street 1:456 W 10TH AVE
Practice Address - Street 2:SUITE 2813
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1240
Practice Address - Country:US
Practice Address - Phone:614-293-3069
Practice Address - Fax:614-293-9684
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-09-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OHRN 219-196363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMINP20981Medicare PIN