Provider Demographics
NPI:1699082610
Name:MITCHELL, VANESSA HOPE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:HOPE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:VANESSA
Other - Middle Name:HOPE
Other - Last Name:SLEIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7210
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:440 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-4631
Practice Address - Country:US
Practice Address - Phone:906-776-9040
Practice Address - Fax:906-774-5950
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5610-23363A00000X
MI5601005843363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1094328OtherNATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS
MI5220028OtherBCBS MI