Provider Demographics
NPI:1205802451
Name:MITCHELL, SANDRA RODRIGUEZ (NURSE)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:RODRIGUEZ
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 LAKE MANOR DR
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-6274
Mailing Address - Country:US
Mailing Address - Phone:912-573-4220
Mailing Address - Fax:
Practice Address - Street 1:148 LAKE MANOR DR
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6274
Practice Address - Country:US
Practice Address - Phone:912-573-4220
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY260444163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics