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NPI Code Detail

MEDICARE: BERTHANN M MITCHELL FNP-BC

MEDICARE: BERTHANN M MITCHELL FNP-BC
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
1363LF0000XFamily Nurse Practitioner4704202045MI

General Provider Information

NPI Number : 1780343277
Entity Type Code : Individual
Provider Name (Legal Business Name) : BERTHANN M MITCHELL FNP-BC
Provider Business Mailing Address
First Line : PO BOX 324
Second Line :
City : BERRIEN SPRINGS
State : MI
Zip : 49103-0324
Country : US
Telephone Number : 269-277-4484
Fax Number :
Provider Business Practice Location Address
First Line : 25990 CROCKER BLVD
Second Line :
City : HARRISON TOWNSHIP
State : MI
Zip : 48045-3450
Country : US
Telephone Number : 586-466-5466
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2021
Last Update Date : 02/02/2022

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