Healthcare Provider Details

I. General information

NPI: 1669460010
Provider Name (Legal Business Name): SUSAN J. MITCHELL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 03/07/2023
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 S PUBLIC RD STE 100
LAFAYETTE CO
80026-7093
US

IV. Provider business mailing address

1735 S PUBLIC RD STE 203
LAFAYETTE CO
80026-7093
US

V. Phone/Fax

Practice location:
  • Phone: 303-665-9310
  • Fax: 303-665-3397
Mailing address:
  • Phone: 303-665-3036
  • Fax: 303-665-3397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPN.0001242-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: