Provider Demographics
NPI:1922209170
Name:MITCHELL, SHELLEY MILLER (CRNA)
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:MILLER
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 POTRERO AVE # 3C38
Mailing Address - Street 2:SFGH ANESTHESIA
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3518
Mailing Address - Country:US
Mailing Address - Phone:415-206-8213
Mailing Address - Fax:415-206-6014
Practice Address - Street 1:1001 POTRERO AVE # 3C38
Practice Address - Street 2:SFGH ANESTHESIA
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-206-8213
Practice Address - Fax:415-206-6014
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN512627163WM0705X
CACRNA3201367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
107359OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER