Healthcare Provider Details

I. General information

NPI: 1578085429
Provider Name (Legal Business Name): CHRISTINE MITCHELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE BOYER PA-C

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4006 JOHNATHAN ST STE B
WATERLOO IA
50701-9395
US

IV. Provider business mailing address

PO BOX 2758
WATERLOO IA
50704-2758
US

V. Phone/Fax

Practice location:
  • Phone: 319-233-1540
  • Fax:
Mailing address:
  • Phone: 319-235-5390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number087919
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: