Provider Demographics
NPI:1376669788
Name:MITCHELL, ELIZABETH B (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:B
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CLEAR CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-8469
Mailing Address - Country:US
Mailing Address - Phone:603-540-5393
Mailing Address - Fax:
Practice Address - Street 1:275 MAMMOTH RD STE 3
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03109-4133
Practice Address - Country:US
Practice Address - Phone:603-663-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH055877-23-03363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30345079Medicaid
NH000232503Medicare PIN