Provider Demographics
NPI:1437453883
Name:MITCHELL, CHERYL (PA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4156 MANZANITA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-1496
Mailing Address - Country:US
Mailing Address - Phone:916-488-6337
Mailing Address - Fax:
Practice Address - Street 1:4156 MANZANITA AVE STE 100
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-1496
Practice Address - Country:US
Practice Address - Phone:916-488-6337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16081363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant