Provider Demographics
NPI:1528568573
Name:MITCHELL, RHONDA SHANNON (CPM, LM)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:SHANNON
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:MRS
Other - First Name:R.
Other - Middle Name:SHANNON
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPM, LM
Mailing Address - Street 1:28631 NE TOLT HILL RD
Mailing Address - Street 2:
Mailing Address - City:CARNATION
Mailing Address - State:WA
Mailing Address - Zip Code:98014-8205
Mailing Address - Country:US
Mailing Address - Phone:727-667-8039
Mailing Address - Fax:425-274-1553
Practice Address - Street 1:28631 NE TOLT HILL RD
Practice Address - Street 2:
Practice Address - City:CARNATION
Practice Address - State:WA
Practice Address - Zip Code:98014-8205
Practice Address - Country:US
Practice Address - Phone:727-667-8039
Practice Address - Fax:425-274-1553
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X, 174N00000X, 374J00000X
18040002175M00000X
WAMW60861142176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No174H00000XOther Service ProvidersHealth Educator
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No175M00000XOther Service ProvidersMidwife, Lay
No374J00000XNursing Service Related ProvidersDoula