=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528568573
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RHONDA SHANNON MITCHELL CPM, LM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2018
-----------------------------------------------------
Last Update Date | 04/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28631 NE TOLT HILL RD
-----------------------------------------------------
City | CARNATION
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98014-8205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-667-8039
-----------------------------------------------------
Fax | 425-274-1553
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28631 NE TOLT HILL RD
-----------------------------------------------------
City | CARNATION
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98014-8205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-667-8039
-----------------------------------------------------
Fax | 425-274-1553
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174H00000X
-----------------------------------------------------
Taxonomy Name | Health Educator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174N00000X
-----------------------------------------------------
Taxonomy Name | Lactation Consultant (Non-RN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 175M00000X
-----------------------------------------------------
Taxonomy Name | Lay Midwife
-----------------------------------------------------
License Number | 18040002
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 374J00000X
-----------------------------------------------------
Taxonomy Name | Doula
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number | MW60861142
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------