Healthcare Provider Details

I. General information

NPI: 1053108696
Provider Name (Legal Business Name): ALICE MITCHELL CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 JACKSON ST
LOWELL MA
01852-2103
US

IV. Provider business mailing address

161 JACKSON ST
LOWELL MA
01852-2103
US

V. Phone/Fax

Practice location:
  • Phone: 978-937-9700
  • Fax: 978-221-6728
Mailing address:
  • Phone: 978-937-9700
  • Fax: 978-221-6728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN2390219
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: