Provider Demographics
NPI:1366686156
Name:MITCHELL, TISHA
Entity Type:Individual
Prefix:
First Name:TISHA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W. INTERNATIONAL AIRPORT RD.
Mailing Address - Street 2:SUITE 15
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-1116
Mailing Address - Country:US
Mailing Address - Phone:907-274-0038
Mailing Address - Fax:907-222-0511
Practice Address - Street 1:401 W. INTERNATIONAL AIRPORT RD.
Practice Address - Street 2:SUITE 15
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1116
Practice Address - Country:US
Practice Address - Phone:907-274-0038
Practice Address - Fax:907-222-0511
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator