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General NPI Number Information
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NPI Number | 1639628753
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Entity Type | Individual
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Provider Name | MARY POULIAS MITCHELL NP-C
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Gender | Female
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Dates
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Enumeration Date | 09/30/2016
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 64 BOYDEN RD
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City | HOLDEN
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State | MA
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Zip | 01520-2570
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Country | US
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Telephone | 508-829-6765
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Fax | 978-840-1680
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Provider Business Mailing Address
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Address Line | 5 NEPONSET ST
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City | WORCESTER
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State | MA
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Zip | 01606-2714
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Country | US
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Telephone | 508-368-5532
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN2280889
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN2280889
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License Number State | MA
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