Provider Demographics
NPI:1578330056
Name:MITCHELL, OLIVIA PAIGE (PA)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:PAIGE
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:PO BOX 10001
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950-8901
Mailing Address - Country:US
Mailing Address - Phone:670-785-8045
Mailing Address - Fax:
Practice Address - Street 1:292 N 400 E
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-2408
Practice Address - Country:US
Practice Address - Phone:670-785-8045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program