MEDICARE: MS. NICOLE MITTER CNIM

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	246ZE0600X	Electroneurodiagnostic Specialist/Technologist	9902362	GA

General Provider Information

NPI Number	:	1346668159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NICOLE MITTER CNIM

Provider Business Mailing Address
First Line	:	925B PEACHTREE ST NE
Second Line	:	460
City	:	ATLANTA
State	:	GA
Zip	:	30309-3918
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	925B PEACHTREE ST NE
Second Line	:	460
City	:	ATLANTA
State	:	GA
Zip	:	30309-3918
Country	:	US
Telephone Number	:	404-428-7041
Fax Number	:

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

Provider Enumeration Date	:	03/31/2014
Last Update Date	:	03/31/2014

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