Individual
MRS. STACIE COLLEEN MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
23 W GLANN RD, APALACHIN, NY 13732-4026
(607) 725-0889
(607) 625-4251
Mailing address
23 W GLANN RD, APALACHIN, NY 13732-4026
(607) 725-0889
(607) 625-4251
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
006640
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03320656
—
NY
Enumeration date
05/13/2013
Last updated
02/27/2015
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