Healthcare Provider Details

I. General information

NPI: 1811756976
Provider Name (Legal Business Name): KRYSTYNA MITCHELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 LOGAN AVE
WATERLOO IA
50703-1916
US

IV. Provider business mailing address

1050 190TH ST
IONIA IA
50645-9478
US

V. Phone/Fax

Practice location:
  • Phone: 319-235-3549
  • Fax:
Mailing address:
  • Phone: 641-426-0885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberH191018
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number167540
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: