Provider Demographics
NPI:1760750608
Name:MITCHELL, DOLMA
Entity Type:Individual
Prefix:MS
First Name:DOLMA
Middle Name:
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 1:533 BEACH 66 STREET
Mailing Address - Street 2:APT#2
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692
Mailing Address - Country:US
Mailing Address - Phone:347-992-3868
Mailing Address - Fax:
Practice Address - Street 1:533 BEACH 66 STREET
Practice Address - Street 2:APT#2
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692
Practice Address - Country:US
Practice Address - Phone:347-992-3868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307483164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse