MEDICARE: MRS. RACHEL MITCHELL CPNP

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	363LP0200X	Pediatric Nurse Practitioner	003142	CT

General Provider Information

NPI Number	:	1912108994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RACHEL MITCHELL CPNP

Provider Business Mailing Address
First Line	:	53 CHAMBERLAIN RD
Second Line	:
City	:	WETHERSFIELD
State	:	CT
Zip	:	06109-3008
Country	:	US
Telephone Number	:	860-529-8199
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 N MAIN ST
Second Line	:	SUITE 110
City	:	WEST HARTFORD
State	:	CT
Zip	:	06107-1932
Country	:	US
Telephone Number	:	860-232-2626
Fax Number	:	860-233-5407

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

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	07/08/2007

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