Provider Demographics
NPI:1497070460
Name:MITCHELL, NOELLE LAUREN (RPA-C)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:LAUREN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 E 20TH ST APT MG
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-1300
Mailing Address - Country:US
Mailing Address - Phone:212-777-8407
Mailing Address - Fax:
Practice Address - Street 1:530 E 20TH ST APT MG
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-1300
Practice Address - Country:US
Practice Address - Phone:212-777-8407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23-013895363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant