Provider Demographics
NPI:1679712913
Name:MITCHELL, SALLY JANE (RNC,CHT)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:JANE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RNC,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 COUNTY HOSPITAL RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:QUINCY
Mailing Address - State:CA
Mailing Address - Zip Code:95971-9180
Mailing Address - Country:US
Mailing Address - Phone:530-283-6307
Mailing Address - Fax:
Practice Address - Street 1:270 COUNTY HOSPITAL RD
Practice Address - Street 2:SUITE 109
Practice Address - City:QUINCY
Practice Address - State:CA
Practice Address - Zip Code:95971-9180
Practice Address - Country:US
Practice Address - Phone:530-283-6307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN31216163W00000X
OR200841972RN163W00000X, 101YM0800X
CARN541455163W00000X
CA63713 PUBLIC HEALTH163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health