Healthcare Provider Details

I. General information

NPI: 1205939113
Provider Name (Legal Business Name): JOANN VICTORIA MITCHELL WHCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 MDG/SGOMG UNIT 7745
APO AE
09720
PT

IV. Provider business mailing address

PSC 76, BOX 988
APO AE
09720
PT

V. Phone/Fax

Practice location:
  • Phone: 351295573239
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberAP1382
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: