Provider Demographics
NPI:1962480665
Name:MITCHELL, MARELLE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MARELLE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOBELVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37097-3235
Mailing Address - Country:US
Mailing Address - Phone:931-593-2277
Mailing Address - Fax:931-593-2517
Practice Address - Street 1:236 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LOBELVILLE
Practice Address - State:TN
Practice Address - Zip Code:37097-3235
Practice Address - Country:US
Practice Address - Phone:931-593-2277
Practice Address - Fax:931-593-2517
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005050163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNS86501Medicare UPIN