Provider Demographics
NPI:1225755390
Name:MITCHELL, MOLLY MAUREEN (NP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:MAUREEN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5203 FERNRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-4122
Mailing Address - Country:US
Mailing Address - Phone:805-216-1415
Mailing Address - Fax:
Practice Address - Street 1:EXER URGENT CARE
Practice Address - Street 2:359 CARMEN DR.
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010
Practice Address - Country:US
Practice Address - Phone:805-914-5592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022241363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics