MEDICARE: MS. SUSAN ANNE MITCHELL A.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	FL-577	FL

General Provider Information

NPI Number	:	1114091535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN ANNE MITCHELL A.P.

Provider Business Mailing Address
First Line	:	4448 BOUGAINVILLA DR APT 5
Second Line	:
City	:	LAUDERDALE BY THE SEA
State	:	FL
Zip	:	33308-3693
Country	:	US
Telephone Number	:	954-771-2813
Fax Number	:

Provider Business Practice Location Address
First Line	:	231B COMMERCIAL BLVD
Second Line	:
City	:	LAUDERDALE BY THE SEA
State	:	FL
Zip	:	33308-4441
Country	:	US
Telephone Number	:	954-772-1919
Fax Number	:	954-772-1841

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/08/2007

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