Provider Demographics
NPI:1396045787
Name:MITCHELL, MICHELE NICOLE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:NICOLE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MISS
Other - First Name:MICHELE
Other - Middle Name:NICOLE
Other - Last Name:SNEED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:5467 UPPER MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-1854
Mailing Address - Country:US
Mailing Address - Phone:716-439-7400
Mailing Address - Fax:716-439-7521
Practice Address - Street 1:5467 UPPER MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-1854
Practice Address - Country:US
Practice Address - Phone:716-439-7400
Practice Address - Fax:716-439-7521
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305554-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health