MEDICARE: MAGHEN MITCHELL NP-C

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	100148	OK

General Provider Information

NPI Number	:	1689068371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAGHEN MITCHELL NP-C

Provider Business Mailing Address
First Line	:	3323 NW 21ST ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-3013
Country	:	US
Telephone Number	:	405-795-9922
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 NW 23RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-2213
Country	:	US
Telephone Number	:	405-602-2525
Fax Number	:

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

Provider Enumeration Date	:	03/20/2015
Last Update Date	:	06/05/2015

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