=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033209317
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICIA JOAN MITCHELL NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2006
-----------------------------------------------------
Last Update Date | 03/17/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 736 IRVING AVE
-----------------------------------------------------
City | SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13210-1687
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-470-8334
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6302 MUSTANG RD
-----------------------------------------------------
City | BALDWINSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13027-9045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-635-2674
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | F300736
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------