Provider Demographics
NPI:1417510314
Name:MITCHELL, DEBORA ANN (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:DEBORA
Middle Name:ANN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8273 SW LORI WAY
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-6909
Mailing Address - Country:US
Mailing Address - Phone:734-276-6075
Mailing Address - Fax:
Practice Address - Street 1:6464 SW BORLAND RD STE A2
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8854
Practice Address - Country:US
Practice Address - Phone:503-885-1515
Practice Address - Fax:503-885-1520
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60932537363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty