Provider Demographics
NPI:1902038268
Name:MITCHELL, AMANDA KATHERINE (FNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KATHERINE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 ARSENAL PL
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-3171
Mailing Address - Country:US
Mailing Address - Phone:888-897-1887
Mailing Address - Fax:857-343-8192
Practice Address - Street 1:260 ARSENAL PL
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-3171
Practice Address - Country:US
Practice Address - Phone:888-897-1887
Practice Address - Fax:857-343-8192
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-19
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA20090061365363LF0000X
MARN250826363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily