Provider Demographics
NPI:1710951066
Name:MITCHELL, PATRICIA DIANE (RN)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:DIANE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:DIANE
Other - Last Name:MCGUIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1888 HAYMARKET RD
Mailing Address - Street 2:UNIT 2
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-7191
Mailing Address - Country:US
Mailing Address - Phone:262-408-2111
Mailing Address - Fax:
Practice Address - Street 1:1888 HAYMARKET RD
Practice Address - Street 2:UNIT 2
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-7191
Practice Address - Country:US
Practice Address - Phone:262-408-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39974700Medicaid