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NPI Code Detail

MEDICARE: SAMUEL JOHN MITZEL CRNA

MEDICARE: SAMUEL JOHN MITZEL CRNA
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
1367500000XCertified Registered Nurse AnesthetistR 168226 5MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457466963
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMUEL JOHN MITZEL CRNA
Provider Business Mailing Address
First Line : 2907 70TH AVE
Second Line :
City : GREELEY
State : CO
Zip : 80634-8969
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3333 S WADSWORTH BLVD UNIT D100
Second Line :
City : LAKEWOOD
State : CO
Zip : 80227-5117
Country : US
Telephone Number : 303-205-1090
Fax Number : 303-205-5534
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2006
Last Update Date : 09/20/2013

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