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NPI Code Detail

MEDICARE: AMYRE LAKEVIA MITCHELL NP

MEDICARE: AMYRE LAKEVIA MITCHELL NP
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
1363L00000XNurse Practitioner4704256658MI
2363LF0000XFamily Nurse Practitioner4704256658MI

General Provider Information

NPI Number : 1538440581
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMYRE LAKEVIA MITCHELL NP
Provider Business Mailing Address
First Line : 3621 SOUTH STATE STREET
Second Line : 700 KMS PLACE
City : ANN ARBOR
State : MI
Zip : 48108
Country : US
Telephone Number : 734-936-2047
Fax Number :
Provider Business Practice Location Address
First Line : 1500 EAST MEDICAL CENTER DRIVE
Second Line : B2 FLOOR UNIVERSITY HOSPITAL RM C490
City : ANN ARBOR
State : MI
Zip : 48109-5010
Country : US
Telephone Number : 734-936-4300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2011
Last Update Date : 08/19/2016

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