Provider Demographics
NPI:1215074372
Name:MITCHELL, LORI-ANNE (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:LORI-ANNE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 DOGWOOD ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-1033
Mailing Address - Country:US
Mailing Address - Phone:845-336-5867
Mailing Address - Fax:845-691-1065
Practice Address - Street 1:190 FOXHOLLOW ROAD
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572
Practice Address - Country:US
Practice Address - Phone:845-876-5628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY544682-1324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility