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General NPI Number Information
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NPI Number | 1659187300
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Entity Type | Individual
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Provider Name | MITTAL PATEL
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Gender | Female
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Dates
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Enumeration Date | 12/07/2024
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Last Update Date | 12/07/2024
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Provider Practice Location Address
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Address Line | 12228 PAXTON GLEN TER
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City | GLEN ALLEN
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State | VA
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Zip | 23059-7166
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Country | US
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Telephone | 805-504-6783
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Fax |
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Provider Business Mailing Address
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Address Line | 12228 PAXTON GLEN TER
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City | GLEN ALLEN
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State | VA
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Zip | 23059-7166
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Country | US
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Telephone | 805-504-6783
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0024187380
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 0001275667
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License Number State | VA
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