Provider Demographics
NPI:1356553291
Name:MITCHELL, DIANE (NURSE)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
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 1:6814 KINDRED ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-2221
Mailing Address - Country:US
Mailing Address - Phone:215-214-2717
Mailing Address - Fax:
Practice Address - Street 1:6814 KINDRED ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-2221
Practice Address - Country:US
Practice Address - Phone:215-214-2717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN096369L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse