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General NPI Number Information
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NPI Number | 1205181526
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Entity Type | Individual
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Provider Name | CONSTANCE MITCHELL NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 07/24/2012
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 2425 STOCKTON BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95817-2215
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Country | US
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Telephone | 707-672-6536
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Fax | 916-453-5038
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Provider Business Mailing Address
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Address Line | 2425 STOCKTON BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95817-2215
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Country | US
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Telephone | 707-672-6536
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Fax | 916-453-5038
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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 | 95009958
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN781915
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License Number State | CA
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