Provider Demographics
NPI:1851485551
Name:MITCHELL, MIRIAM ANNA-LISA (ND)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:ANNA-LISA
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:MIRIAM
Other - Middle Name:A
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ND
Mailing Address - Street 1:1310 COBURG RD STE 1
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-5200
Mailing Address - Country:US
Mailing Address - Phone:541-799-0070
Mailing Address - Fax:541-799-0078
Practice Address - Street 1:1310 COBURG RD STE 1
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-5200
Practice Address - Country:US
Practice Address - Phone:541-799-0070
Practice Address - Fax:541-799-0078
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2022-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1097175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR230568Medicaid