Provider Demographics
NPI:1679563977
Name:MITCHELL, ANTHONY (FNP)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:FNP
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 24366
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0366
Mailing Address - Country:US
Mailing Address - Phone:206-598-0502
Mailing Address - Fax:206-598-0516
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:BOX 356174
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6174
Practice Address - Country:US
Practice Address - Phone:206-598-2368
Practice Address - Fax:206-598-8119
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-0042312363LF0000X
WAAP30007571363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P61448Medicare UPIN