Provider Demographics
NPI:1598549669
Name:MITCHELL, LOIS AMANDLA AWETU (RN)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:AMANDLA AWETU
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15640 W MINNEZONA AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-6387
Mailing Address - Country:US
Mailing Address - Phone:770-630-5949
Mailing Address - Fax:
Practice Address - Street 1:15640 W MINNEZONA AVE
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-6387
Practice Address - Country:US
Practice Address - Phone:770-630-5949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ244647163WC0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine