MEDICARE: ATLEE MITCHELL NP

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	364SG0600X	Gerontology Clinical Nurse Specialist	95160816	CA
2	363LA2100X	Acute Care Nurse Practitioner	95160816	CA

General Provider Information

NPI Number	:	1477358059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ATLEE MITCHELL NP

Provider Business Mailing Address
First Line	:	1505 WILSON TER STE 150
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91206-4076
Country	:	US
Telephone Number	:	818-484-8059
Fax Number	:	818-484-8049

Provider Business Practice Location Address
First Line	:	1615 GREENFIELD AVE APT 15
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-3572
Country	:	US
Telephone Number	:	859-468-6254
Fax Number	:

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

Provider Enumeration Date	:	02/17/2025
Last Update Date	:	02/17/2025

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