Provider Demographics
NPI:1578635017
Name:MITCHELL, ORAMAE ROZALENE (CNP)
Entity Type:Individual
Prefix:
First Name:ORAMAE
Middle Name:ROZALENE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:ORAMAE
Other - Middle Name:ROZALENE
Other - Last Name:VANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNP
Mailing Address - Street 1:1471 COMO AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-2542
Mailing Address - Country:US
Mailing Address - Phone:651-646-2601
Mailing Address - Fax:
Practice Address - Street 1:410 CHURCH ST SE
Practice Address - Street 2:BOYNTON HEALTH SERVICE
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0340
Practice Address - Country:US
Practice Address - Phone:612-625-8400
Practice Address - Fax:612-625-1434
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR053670-7363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNS78905Medicare UPIN