Provider Demographics
NPI:1477340073
Name:MITCHELL, STEPHANIE (LM, CPM)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 E PUEBLO AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-5124
Mailing Address - Country:US
Mailing Address - Phone:480-427-0142
Mailing Address - Fax:
Practice Address - Street 1:4121 E PUEBLO AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-5124
Practice Address - Country:US
Practice Address - Phone:480-427-0142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLM293176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife