MEDICARE: MRS. RITA SUE MITCHELL RN,MSN, FNP

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	363LF0000X	Family Nurse Practitioner	601620	TX
2	163WA2000X	Administrator Registered Nurse	601620	TX

General Provider Information

NPI Number	:	1790978088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RITA SUE MITCHELL RN,MSN, FNP

Provider Business Mailing Address
First Line	:	10510 HARTFORD AVE
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79423-6012
Country	:	US
Telephone Number	:	806-239-0144
Fax Number	:

Provider Business Practice Location Address
First Line	:	4320 19TH ST
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79407-2407
Country	:	US
Telephone Number	:	806-795-1774
Fax Number	:

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

Provider Enumeration Date	:	08/21/2007
Last Update Date	:	03/31/2008

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