Provider Demographics
NPI:1831367531
Name:MITCHELL, ANNETTE M (RN,MSN,CRNP)
Entity type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:M
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RN,MSN,CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S 11TH ST
Mailing Address - Street 2:SUITE 6210
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4824
Mailing Address - Country:US
Mailing Address - Phone:215-955-5322
Mailing Address - Fax:215-503-5874
Practice Address - Street 1:111 S 11TH ST
Practice Address - Street 2:SUITE 6210
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4824
Practice Address - Country:US
Practice Address - Phone:215-955-5322
Practice Address - Fax:215-503-5874
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2015-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP003973P363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102887788Medicaid
PA325898Medicare PIN