Provider Demographics
NPI:1912108994
Name:MITCHELL, RACHEL (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 CHAMBERLAIN RD
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-3008
Mailing Address - Country:US
Mailing Address - Phone:860-529-8199
Mailing Address - Fax:
Practice Address - Street 1:12 N MAIN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1932
Practice Address - Country:US
Practice Address - Phone:860-232-2626
Practice Address - Fax:860-233-5407
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003142363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics