Provider Demographics
NPI:1386989408
Name:MITCHAM, ANITA (RN)
Entity type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:
Last Name:MITCHAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 BENNETT ST
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-1714
Mailing Address - Country:US
Mailing Address - Phone:360-855-3674
Mailing Address - Fax:360-855-3556
Practice Address - Street 1:700 BENNETT ST
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-1714
Practice Address - Country:US
Practice Address - Phone:360-855-3674
Practice Address - Fax:360-855-3556
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00136005163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse