Provider Demographics
NPI:1982789624
Name:MITCHELL, NANCY S (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:S
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80121-1623
Mailing Address - Country:US
Mailing Address - Phone:720-488-0330
Mailing Address - Fax:
Practice Address - Street 1:2405 GARDEN LN
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80121-1623
Practice Address - Country:US
Practice Address - Phone:720-488-0330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40795208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO71606220Medicaid
D93156Medicare UPIN
CO71606220Medicaid