Basic Information
| Provider Information | |||||||||
| NPI: | 1144981572 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MITCHEM | ||||||||
| FirstName: | JOSHUA | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3519 RICHMOND DR | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805265995 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702040300 | ||||||||
| FaxNumber: | 9702269041 | ||||||||
| Practice Location | |||||||||
| Address1: | 3519 RICHMOND DR | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805265995 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702040300 | ||||||||
| FaxNumber: | 9702269041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2022 | ||||||||
| LastUpdateDate: | 05/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | C-APN.0003769-C-NP | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.