Provider Demographics
NPI:1689014177
Name:MITCHELL, HEIDI DIANA (RN)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:DIANA
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:DIANA
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:17470 NEW YORK HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95919-9703
Mailing Address - Country:US
Mailing Address - Phone:909-446-7776
Mailing Address - Fax:
Practice Address - Street 1:34552 MARR DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-7458
Practice Address - Country:US
Practice Address - Phone:909-446-7776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA694066163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse