MEDICARE: MRS. ARLENE NICOLE MITCHELL LPN

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	164W00000X	Licensed Practical Nurse	311568	NY

General Provider Information

NPI Number	:	1285971317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ARLENE NICOLE MITCHELL LPN

Provider Business Mailing Address
First Line	:	47 BUFFALO AVE APT 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11233-3035
Country	:	US
Telephone Number	:	646-545-0443
Fax Number	:	347-405-6692

Provider Business Practice Location Address
First Line	:	47 BUFFALO AVE APT 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11233-3035
Country	:	US
Telephone Number	:	646-545-0443
Fax Number	:	347-405-6692

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

Provider Enumeration Date	:	01/09/2013
Last Update Date	:	01/09/2013

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