MEDICARE: TYWANA MITCHELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1023656253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYWANA MITCHELL

Provider Business Mailing Address
First Line	:	8520 W PALM LN UNIT 1032
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85037-3906
Country	:	US
Telephone Number	:	480-386-4071
Fax Number	:

Provider Business Practice Location Address
First Line	:	8520 W PALM LN UNIT 1032
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85037-3906
Country	:	US
Telephone Number	:	480-386-4071
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2019
Last Update Date	:	12/18/2019

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Directions to “ TYWANA MITCHELL ” Practice Location

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