Healthcare Provider Details

I. General information

NPI: 1528281508
Provider Name (Legal Business Name): ANNE MARIE MITCHELL MS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD WP I 354 C
DETROIT MI
48202-2608
US

IV. Provider business mailing address

571 FRONT ROAD NORTH
AMHERSTBURG ONTARIO
N9V 2V6
CA

V. Phone/Fax

Practice location:
  • Phone: 313-916-8986
  • Fax: 313-916-5008
Mailing address:
  • Phone: 519-736-0240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4704146582
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: