Provider Demographics
NPI:1699409466
Name:MITCHELL, SARA KRISTEN
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:KRISTEN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37594 HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:LUCERNE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92356-7983
Mailing Address - Country:US
Mailing Address - Phone:714-309-6481
Mailing Address - Fax:
Practice Address - Street 1:37594 HOUSTON ST
Practice Address - Street 2:
Practice Address - City:LUCERNE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92356-7983
Practice Address - Country:US
Practice Address - Phone:714-309-6481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251794164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse