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General NPI Number Information
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NPI Number | 1083154850
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Entity Type | Individual
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Provider Name | MIRANDA MITCHELL CPNP-PC, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/27/2017
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 213 COURT ST
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City | MIDDLETOWN
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State | CT
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Zip | 06457-3346
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Country | US
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Telephone | 203-244-7253
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Fax |
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Provider Business Mailing Address
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Address Line | 213 COURT ST
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City | MIDDLETOWN
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State | CT
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Zip | 06457-3346
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Country | US
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Telephone | 203-244-7253
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 8707
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN8707
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License Number State | CT
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