Individual
KATHLEEN M MITCHEOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LNM CNM
Contact information
Practice address
374 GRAND AVENUE, FAIR HAVEN COMMUNITY HEALTH CTR, NEW HAVEN, CT 06513
(203) 777-7411
(203) 777-8506
Mailing address
17 EAST HAYCOCK ROAD, BRANFORD, CT 06405
(203) 488-7035
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
000021
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000219734
CONNECTICARE
—
01
—
400000021CT01
ANTHEM BCBS
—
01
—
PSS4934
OXFORD
—
Enumeration date
09/11/2006
Last updated
07/08/2007
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