Provider Demographics
NPI:1770749848
Name:WHARTON, MITCHELL JAMES (CRNP, CNS)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:JAMES
Last Name:WHARTON
Suffix:
Gender:M
Credentials:CRNP, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 12TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-4422
Mailing Address - Country:US
Mailing Address - Phone:202-446-1100
Mailing Address - Fax:
Practice Address - Street 1:1816 12TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-4422
Practice Address - Country:US
Practice Address - Phone:202-446-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC500022614363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily