Provider Demographics
NPI:1275058026
Name:MITCHENER, JAMES LEE III (RN)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LEE
Last Name:MITCHENER
Suffix:III
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:37568 RIVER OATS LN
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-3571
Mailing Address - Country:US
Mailing Address - Phone:310-562-7734
Mailing Address - Fax:
Practice Address - Street 1:5770 RIVERSIDE DRIVE, BUILDING 601
Practice Address - Street 2:752 MEDICAL SQUADRON
Practice Address - City:MARCH ARB
Practice Address - State:CA
Practice Address - Zip Code:92518
Practice Address - Country:US
Practice Address - Phone:951-655-5167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-12
Last Update Date:2017-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA809401163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty