Provider Demographics
NPI:1902018880
Name:MITCHEL, CYNTHIA MIA (NP,RNC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MIA
Last Name:MITCHEL
Suffix:
Gender:F
Credentials:NP,RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 IRVING DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-1065
Mailing Address - Country:US
Mailing Address - Phone:415-721-2468
Mailing Address - Fax:
Practice Address - Street 1:350 BON AIR CTR STE 200
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904
Practice Address - Country:US
Practice Address - Phone:415-578-3095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN395738163WW0101X
CA395738363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory