Healthcare Provider Details

I. General information

NPI: 1548879885
Provider Name (Legal Business Name): SUZANNE MITCHELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44901 TROTSDALE DR
TEMECULA CA
92592-5875
US

IV. Provider business mailing address

44901 TROTSDALE DR
TEMECULA CA
92592-5875
US

V. Phone/Fax

Practice location:
  • Phone: 760-310-5307
  • Fax:
Mailing address:
  • Phone: 760-310-5307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number159399
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number159399
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number159399
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number159399
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: