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General NPI Number Information
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NPI Number | 1538936869
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Entity Type | Individual
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Provider Name | JOEY ROCHELLE MITCHELL
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Gender | Female
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Dates
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Enumeration Date | 12/06/2023
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 212 W LAKE ST
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City | WACONIA
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State | MN
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Zip | 55387-1014
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Country | US
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Telephone | 456-565-1603
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Fax |
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Provider Business Mailing Address
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Address Line | 9325 500TH ST
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City | RUSH CITY
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State | MN
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Zip | 55069-2107
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Country | US
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Telephone | 612-867-0027
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 11086
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License Number State | MN
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