Provider Demographics
NPI:1386071264
Name:MITSCHA, MAMIE CHOY (ARNP)
Entity type:Individual
Prefix:MRS
First Name:MAMIE
Middle Name:CHOY
Last Name:MITSCHA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
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Mailing Address - Street 1:560 GAGE BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-8650
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-942-2268
Practice Address - Street 1:3950 KEENE RD
Practice Address - Street 2:
Practice Address - City:WEST RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353
Practice Address - Country:US
Practice Address - Phone:509-942-3130
Practice Address - Fax:509-628-8335
Is Sole Proprietor?:No
Enumeration Date:2013-10-09
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY672922163W00000X
CA95039332163W00000X
WAAP60534589363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1386071264Medicaid