Provider Demographics
NPI:1245664333
Name:MITTS, STACEY MICHELLE (RN)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:MICHELLE
Last Name:MITTS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 WALLACE AVE
Mailing Address - Street 2:ACHD NFP SUITE 402
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-2312
Mailing Address - Country:US
Mailing Address - Phone:412-247-7949
Mailing Address - Fax:412-247-7959
Practice Address - Street 1:807 WALLACE AVE
Practice Address - Street 2:ACHD NFP SUITE 402
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15221-2312
Practice Address - Country:US
Practice Address - Phone:412-247-7949
Practice Address - Fax:412-247-7959
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN607475163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse