Provider Demographics
NPI:1700218286
Name:MITCHELL, MICHELLE ANN (RN, CNM, MS, MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ANN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RN, CNM, MS, MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ETHEL RD
Mailing Address - Street 2:SUITE 402A
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2841
Mailing Address - Country:US
Mailing Address - Phone:732-452-9099
Mailing Address - Fax:732-287-3301
Practice Address - Street 1:4 ETHEL RD
Practice Address - Street 2:SUITE 402A
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-2841
Practice Address - Country:US
Practice Address - Phone:732-452-9099
Practice Address - Fax:732-287-3301
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25ME00052900367A00000X
NJ25ME00052901367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife