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General NPI Number Information
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NPI Number | 1205802451
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Entity Type | Individual
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Provider Name | SANDRA RODRIGUEZ MITCHELL NURSE
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Gender | Female
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Dates
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Enumeration Date | 02/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 148 LAKE MANOR DR
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City | KINGSLAND
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State | GA
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Zip | 31548-6274
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Country | US
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Telephone | 912-573-4220
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Fax |
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Provider Business Mailing Address
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Address Line | 148 LAKE MANOR DR
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City | KINGSLAND
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State | GA
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Zip | 31548-6274
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Country | US
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Telephone | 912-573-4220
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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 | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | 260444
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License Number State | NY
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