MEDICARE: MS. DENISE MITCHELL NURSE

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	272709	NY

General Provider Information

NPI Number	:	1528387289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DENISE MITCHELL NURSE

Provider Business Mailing Address
First Line	:	25 PENATAQUIT AVE APT 1A
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-8049
Country	:	US
Telephone Number	:	631-532-7286
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 PENATAQUIT AVE APT 1A
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-8049
Country	:	US
Telephone Number	:	631-532-7286
Fax Number	:

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

Provider Enumeration Date	:	05/20/2010
Last Update Date	:	05/20/2010

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