Healthcare Provider Details

I. General information

NPI: 1548587090
Provider Name (Legal Business Name): SUSAN D MITCHELL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN PATRONE

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 01/14/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1795 FORTSTONE LN
COLUMBUS OH
43228-3873
US

IV. Provider business mailing address

1795 FORTSTONE LN
COLUMBUS OH
43228-3873
US

V. Phone/Fax

Practice location:
  • Phone: 614-458-8494
  • Fax:
Mailing address:
  • Phone: 614-588-4946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0028200
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 353135
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: