MEDICARE: MS. SONIA L MITCHELL

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	164W00000X	Licensed Practical Nurse	164W00000X	PA

General Provider Information

NPI Number	:	1831217611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SONIA L MITCHELL

Provider Business Mailing Address
First Line	:	282 CONGO NIANTIC RD
Second Line	:
City	:	BARTO
State	:	PA
Zip	:	19504-9353
Country	:	US
Telephone Number	:	610-652-2285
Fax Number	:	610-933-4080

Provider Business Practice Location Address
First Line	:	1288 VALLEY FORGE RD UNIT 69
Second Line	:
City	:	PHOENIXVILLE
State	:	PA
Zip	:	19460-2687
Country	:	US
Telephone Number	:	610-933-9483
Fax Number	:	610-933-4080

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

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	02/27/2014

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