Provider Demographics
NPI:1346228368
Name:MITCHELL-MOLLARD, NANCY D (CRNA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:D
Last Name:MITCHELL-MOLLARD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11610 N LOU AL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2634
Mailing Address - Country:US
Mailing Address - Phone:713-463-6546
Mailing Address - Fax:
Practice Address - Street 1:1515 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4000
Practice Address - Country:US
Practice Address - Phone:713-792-8666
Practice Address - Fax:713-563-0526
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX238520367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX088770507Medicaid
TX088770505Medicaid
TX8L20052Medicare PIN
TX471647YKQHMedicare PIN
TX8L16233Medicare PIN
TX8C9450Medicare PIN
TX088770507Medicaid
TX8D2870Medicare PIN