Provider Demographics
NPI:1992777163
Name:MITCHELL, CHERYL A (APRN)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1717 SHAFFER ST
Mailing Address - Street 2:SUITE 232
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1647
Mailing Address - Country:US
Mailing Address - Phone:269-226-5050
Mailing Address - Fax:269-226-5034
Practice Address - Street 1:1717 SHAFFER ST
Practice Address - Street 2:SUITE 232
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1647
Practice Address - Country:US
Practice Address - Phone:269-226-5050
Practice Address - Fax:269-226-5034
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2010-05-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704164704363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4832122Medicaid
MIN54580008Medicare PIN