Healthcare Provider Details

I. General information

NPI: 1457432841
Provider Name (Legal Business Name): ELIZABETH A MITCHELL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 MAIN ST
OLEAN NY
14760-1515
US

IV. Provider business mailing address

PO BOX 583
OLEAN NY
14760-0583
US

V. Phone/Fax

Practice location:
  • Phone: 716-372-4212
  • Fax: 716-373-9167
Mailing address:
  • Phone: 716-372-4212
  • Fax: 716-373-9167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF302552-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF333499-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP007790
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: