Healthcare Provider Details

I. General information

NPI: 1477358059
Provider Name (Legal Business Name): ATLEE MITCHELL NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 GREENFIELD AVE APT 15
LOS ANGELES CA
90025-3572
US

IV. Provider business mailing address

1505 WILSON TER STE 150
GLENDALE CA
91206-4076
US

V. Phone/Fax

Practice location:
  • Phone: 859-468-6254
  • Fax:
Mailing address:
  • Phone: 818-484-8059
  • Fax: 818-484-8049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number95160816
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95160816
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: