Provider Demographics
NPI:1154550465
Name:MITCHELL, STACEY MICHELLE (RN, ANP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:MICHELLE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RN, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:799 E HAMPDEN AVE STE 525
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2786
Mailing Address - Country:US
Mailing Address - Phone:303-321-2644
Mailing Address - Fax:303-321-2446
Practice Address - Street 1:799 E HAMPDEN AVE STE 525
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2786
Practice Address - Country:US
Practice Address - Phone:303-321-2644
Practice Address - Fax:303-321-2446
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO175391363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health