Individual
NICOLE MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
78078 COUNTRY CLUB DR, BERMUDA DUNES, CA 92203-8173
(760) 345-9934
Mailing address
1211 W 4TH ST, GRAND ISLAND, NE 68801-4407
(402) 460-0243
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA48584
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FLJ899323208
BLUE CROSS BLUE SHIELD
NE
Enumeration date
10/15/2017
Last updated
10/15/2017
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