Provider Demographics
NPI:1861824773
Name:MITCHELL, CLEMAINE CHARITA (APN-C)
Entity Type:Individual
Prefix:
First Name:CLEMAINE
Middle Name:CHARITA
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 MEADOWLANDS PKWY
Mailing Address - Street 2:5
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-2925
Mailing Address - Country:US
Mailing Address - Phone:551-257-7015
Mailing Address - Fax:201-552-2358
Practice Address - Street 1:1167 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-5417
Practice Address - Country:US
Practice Address - Phone:718-778-0198
Practice Address - Fax:718-221-8169
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF338530363LF0000X
NJ26NR11384700364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NY00695941Medicaid
NYW6L111Medicare Oscar/Certification
NY331954Medicare Oscar/Certification