Provider Demographics
NPI:1255871968
Name:MITCHELL, LISA A (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:333 N SUMMIT ST FL 7
Mailing Address - Street 2:HCR MANORCARE MEDICAL SERVICES / HEARTLAND CARE PARTNER
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-2615
Mailing Address - Country:US
Mailing Address - Phone:800-427-1902
Mailing Address - Fax:419-531-2664
Practice Address - Street 1:2320 E BELTLINE AVE SE
Practice Address - Street 2:HEARTLAND CARE PARTNERS
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5906
Practice Address - Country:US
Practice Address - Phone:800-427-1902
Practice Address - Fax:419-531-2664
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704254454363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner