Healthcare Provider Details

I. General information

NPI: 1669983771
Provider Name (Legal Business Name): HANNAH MITCHELL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 NE MAY LN
MCMINNVILLE OR
97128-9272
US

IV. Provider business mailing address

PO BOX 6149
BEAVERTON OR
97007-0149
US

V. Phone/Fax

Practice location:
  • Phone: 503-359-5564
  • Fax: 503-357-4371
Mailing address:
  • Phone: 503-352-8657
  • Fax: 503-352-8658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA185098
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: