MEDICARE: ELIZABETH MITCHKO

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	363LF0000X	Family Nurse Practitioner	71006838A	IN

General Provider Information

NPI Number	:	1386182954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MITCHKO

Provider Business Mailing Address
First Line	:	14297 BERGEN BLVD STE 125
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060-3420
Country	:	US
Telephone Number	:	317-512-5105
Fax Number	:

Provider Business Practice Location Address
First Line	:	14297 BERGEN BLVD STE 125
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060-3420
Country	:	US
Telephone Number	:	317-900-1633
Fax Number	:

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

Provider Enumeration Date	:	02/03/2017
Last Update Date	:	02/07/2025

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