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1871788570 NPI number — ROCHELLE NELL MITAS ACNP-C

NPI Number: 1871788570
Health Care Provider/Practitioner: ROCHELLE NELL MITAS ACNP-C

Information about “1871788570” NPI (ROCHELLE NELL MITAS ACNP-C) exists in 1871788570 in HTML format HTML  |  1871788570 in plain Text format TXT  |  1871788570 in PDF (Portable Document Format) PDF  |  1871788570 in an XML format XML  formats.

NPI Number : 1871788570 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1871788570",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MITAS",
    "FirstName": "ROCHELLE",
    "MiddleName": "NELL",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "ACNP-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "560 W MITCHELL ST",
    "SecondLineMailingAddress": "SUITE #400",
    "MailingAddressCityName": "PETOSKEY",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "49770-2275",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "231-487-2490",
    "MailingAddressFaxNumber": "231-487-6055",
    "FirstLinePracticeLocationAddress": "560 W MITCHELL ST",
    "SecondLinePracticeLocationAddress": "SUITE #400",
    "PracticeLocationAddressCityName": "PETOSKEY",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "49770-2275",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "231-487-2490",
    "PracticeLocationAddressFaxNumber": "231-487-6055",
    "EnumerationDate": "09/06/2007",
    "LastUpdateDate": "09/06/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LA2100X",
        "TaxonomyName": "Acute Care Nurse Practitioner",
        "LicenseNumber": "4704212985",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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