Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | SP009128 | PA |
NPI | 1003918640 |
---|---|
Provider Name | Susan M. Mitchell |
First Address | Du Bois, PA 15801-0447 |
Second Address | Du Bois, PA 15801-1440 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2006 |
Last Update Date | 21/01/2016 |