MEDICARE: HEATHER C 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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	F360491	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00590390	OTHER	NY	MEDICARE NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	F360491	OTHER	NY	NP

General Provider Information

NPI Number	:	1881811958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER C MITCHELL

Provider Business Mailing Address
First Line	:	85 WEST BURNSIDE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10453
Country	:	US
Telephone Number	:	718-716-4400
Fax Number	:	718-228-7471

Provider Business Practice Location Address
First Line	:	2700 GRAND CONCOURSE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-4918
Country	:	US
Telephone Number	:	718-708-4040
Fax Number	:	718-708-6040

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	04/11/2025

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Directions to “ HEATHER C MITCHELL ” Practice Location

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