Healthcare Provider Details

I. General information

NPI: 1548994858
Provider Name (Legal Business Name): JACQUELYN MITCHELL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 MIRANDA AVE
PALO ALTO CA
94304-1207
US

IV. Provider business mailing address

18281 BERTA CANYON RD
SALINAS CA
93907-1389
US

V. Phone/Fax

Practice location:
  • Phone: 808-258-7150
  • Fax:
Mailing address:
  • Phone: 808-258-7150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SX0200X
TaxonomyOncology Clinical Nurse Specialist
License NumberAPRN818
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: