MEDICARE: ANDREA RAE MITCHELL

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	363L00000X	Nurse Practitioner	13613	WI
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	13613	WI

General Provider Information

NPI Number	:	1346948551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA RAE MITCHELL

Provider Business Mailing Address
First Line	:	W176N4829 CHRISTOPHER CT
Second Line	:
City	:	MENOMONEE FALLS
State	:	WI
Zip	:	53051-6547
Country	:	US
Telephone Number	:	608-774-4324
Fax Number	:

Provider Business Practice Location Address
First Line	:	10424 W BLUEMOUND RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-4331
Country	:	US
Telephone Number	:	414-774-1794
Fax Number	:

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

Provider Enumeration Date	:	02/16/2023
Last Update Date	:	09/30/2025

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