=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619679438
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MITCHELL ADVANCED PRACTICE NURSING & WELLNESS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2023
-----------------------------------------------------
Last Update Date | 03/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 180 OTAY LAKES RD STE 205
-----------------------------------------------------
City | BONITA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91902-2444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-549-8401
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2287 CALLE CATARINA
-----------------------------------------------------
City | CHULA VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91914-4455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/ OWNER
-----------------------------------------------------
Name | KATHLEEN MITCHELL
-----------------------------------------------------
Credential | NP-C
-----------------------------------------------------
Telephone | 619-549-8401
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------