Provider Demographics
NPI:1851483143
Name:MITCHELL, ELIZABETH M (FNP-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1473 BOULDER CREEK CT
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-9109
Mailing Address - Country:US
Mailing Address - Phone:209-815-7249
Mailing Address - Fax:
Practice Address - Street 1:1800 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6019
Practice Address - Country:US
Practice Address - Phone:209-467-6483
Practice Address - Fax:209-461-3462
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 218104363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ09652Medicare UPIN
CAZZZ28509ZMedicare ID - Type Unspecified