Healthcare Provider Details

I. General information

NPI: 1053905901
Provider Name (Legal Business Name): MITCHELL C EMEAHU FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 PANAMA LN UNIT 102B
BAKERSFIELD CA
93313-3511
US

IV. Provider business mailing address

4600 PANAMA LN
BAKERSFIELD CA
93313-3509
US

V. Phone/Fax

Practice location:
  • Phone: 866-707-6664
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95016989
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: