Healthcare Provider Details

I. General information

NPI: 1679563977
Provider Name (Legal Business Name): ANTHONY MITCHELL FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST BOX 356174
SEATTLE WA
98195-6174
US

IV. Provider business mailing address

PO BOX 24366
SEATTLE WA
98124-0366
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-2368
  • Fax: 206-598-8119
Mailing address:
  • Phone: 206-598-0502
  • Fax: 206-598-0516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209-0042312
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30007571
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: