Provider Demographics
NPI:1083154850
Name:MITCHELL, MIRANDA (CPNP-PC, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:CPNP-PC, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 COURT ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3346
Mailing Address - Country:US
Mailing Address - Phone:203-244-7253
Mailing Address - Fax:
Practice Address - Street 1:213 COURT ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3346
Practice Address - Country:US
Practice Address - Phone:203-244-7253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8707363LP0200X
CTAPRN8707363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics