Individual
LORA JEAN MITCHELL-HUBER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
890
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100174170A
—
OK
01
—
970018309
RR MEDICARE
OK
01
—
P00164911
RR MEDICARE
OK
Enumeration date
05/02/2006
Last updated
04/28/2022
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