Healthcare Provider Details

I. General information

NPI: 1639378607
Provider Name (Legal Business Name): SHEILA MITCHELL, P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14201 NE 20TH AVE SUITE 1102
VANCOUVER WA
98686-6410
US

IV. Provider business mailing address

14201 NE 20TH AVE SUITE 1102
VANCOUVER WA
98686-6410
US

V. Phone/Fax

Practice location:
  • Phone: 360-882-7373
  • Fax: 360-882-7673
Mailing address:
  • Phone: 360-882-7373
  • Fax: 360-882-7673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30005464
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00027930
License Number StateWA

VIII. Authorized Official

Name: DR. SHEILA MARIE MITCHELL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 360-882-7373