Provider Demographics
NPI:1194275255
Name:MITCHELL, PATRICIA JOAN (LAC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JOAN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 BEAVER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-6952
Mailing Address - Country:US
Mailing Address - Phone:802-264-9065
Mailing Address - Fax:
Practice Address - Street 1:479 BEAVER CREEK RD
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-6952
Practice Address - Country:US
Practice Address - Phone:802-264-9065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT091.0089378171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist