Basic Information
Provider Information | |||||||||
NPI: | 1003103110 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MITCHELL | ||||||||
FirstName: | SUSANNE | ||||||||
MiddleName: | LORI | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | RN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MITCHELL | ||||||||
OtherFirstName: | LORI | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | MRS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | RN | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 1924 ALCOA HWY | ||||||||
Address2: | 6S | ||||||||
City: | KNOXVILLE | ||||||||
State: | TN | ||||||||
PostalCode: | 379201511 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8653058888 | ||||||||
FaxNumber: | 8653056180 | ||||||||
Practice Location | |||||||||
Address1: | 1924 ALCOA HWY | ||||||||
Address2: | 6S | ||||||||
City: | KNOXVILLE | ||||||||
State: | TN | ||||||||
PostalCode: | 379201511 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8653058888 | ||||||||
FaxNumber: | 8653056180 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/10/2011 | ||||||||
LastUpdateDate: | 07/10/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WX0002X | RN0000110337 | TN | Y |   | Nursing Service Providers | Registered Nurse | Obstetric, High-Risk |
No ID Information.