Provider Demographics
NPI:1427327758
Name:MITCHELL, SADIE E (RN, CCM)
Entity type:Individual
Prefix:MRS
First Name:SADIE
Middle Name:E
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RN, CCM
Other - Prefix:MS
Other - First Name:SADIE
Other - Middle Name:E
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1910 WHISPERING HILLS PLACE
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10918
Mailing Address - Country:US
Mailing Address - Phone:845-469-7487
Mailing Address - Fax:845-469-7487
Practice Address - Street 1:1910 WHISPERHING HILLS PLACE
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10918
Practice Address - Country:US
Practice Address - Phone:845-469-7487
Practice Address - Fax:845-469-7487
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206804163W00000X
NY00120838163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management