Provider Demographics
NPI:1023473402
Name:MITCHELL, SCOTT
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 ROBIN PL
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-8001
Mailing Address - Country:US
Mailing Address - Phone:907-283-5172
Mailing Address - Fax:907-262-8787
Practice Address - Street 1:106 ROBIN PL
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-8001
Practice Address - Country:US
Practice Address - Phone:907-283-5172
Practice Address - Fax:907-262-8787
Is Sole Proprietor?:No
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5112164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse