MEDICARE: CHERYL A MITCHELL APRN

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	4704164704	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992777163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL A MITCHELL APRN

Provider Business Mailing Address
First Line	:	1717 SHAFFER ST
Second Line	:	SUITE 232
City	:	KALAMAZOO
State	:	MI
Zip	:	49048-1647
Country	:	US
Telephone Number	:	269-226-5050
Fax Number	:	269-226-5034

Provider Business Practice Location Address
First Line	:	1717 SHAFFER ST
Second Line	:	SUITE 232
City	:	KALAMAZOO
State	:	MI
Zip	:	49048-1647
Country	:	US
Telephone Number	:	269-226-5050
Fax Number	:	269-226-5034

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

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	05/13/2010

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Directions to “ CHERYL A MITCHELL APRN” Practice Location

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