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General NPI Number Information
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NPI Number | 1912108994
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Entity Type | Individual
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Provider Name | RACHEL MITCHELL CPNP
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Gender | Female
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12 N MAIN ST SUITE 110
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City | WEST HARTFORD
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State | CT
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Zip | 06107-1932
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Country | US
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Telephone | 860-232-2626
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Fax | 860-233-5407
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Provider Business Mailing Address
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Address Line | 53 CHAMBERLAIN RD
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City | WETHERSFIELD
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State | CT
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Zip | 06109-3008
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Country | US
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Telephone | 860-529-8199
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 003142
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License Number State | CT
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