Individual
MAXINE MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
RN246516
GA
364SA2200X
Adult Health Clinical Nurse Specialist
041-235446
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041-235446
STATE LICENSE
IL
Enumeration date
01/23/2007
Last updated
05/04/2016
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