Individual
MARIE A MITCHUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1130 COMMERCIAL ST, ASTORIA, OR 97103-4126
(503) 325-1030
Mailing address
1130 COMMERCIAL ST, ASTORIA, OR 97103-4126
(503) 325-1030
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
NOT REQUIRED
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041635000
BLUE CROSS BLUE SHIELD
OR
05
—
295686
—
OR
05
—
9056722
—
WA
Enumeration date
08/04/2008
Last updated
08/05/2008
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