Provider Demographics
NPI:1659575496
Name:MITCHELL, PRISCILLA R (RD)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:R
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 STATESMAN TER
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-4918
Mailing Address - Country:US
Mailing Address - Phone:781-837-9559
Mailing Address - Fax:
Practice Address - Street 1:4 STATESMAN TER
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-4918
Practice Address - Country:US
Practice Address - Phone:781-837-9559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered