Basic Information
| Provider Information | |||||||||
| NPI: | 1447314695 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MITCHELL | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | MINIHAN | ||||||||
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| Credential: | RNC MS CAPT NC USNR | ||||||||
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| OtherLastName: | MINIHAN | ||||||||
| OtherFirstName: | MARTHA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 25 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | STONINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063781450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605353078 | ||||||||
| FaxNumber: | 8605352806 | ||||||||
| Practice Location | |||||||||
| Address1: | 789 HOWARD AVENUE | ||||||||
| Address2: | YALE NEW HAVEN HOSPITAL WOMENS CENTER | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036884101 | ||||||||
| FaxNumber: | 2036881101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 002646 | CT | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | F4205041 | NY | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 364S00000X | 96313 | MA | X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist |
No ID Information.