Basic Information
| Provider Information | |||||||||
| NPI: | 1902018880 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MITCHEL | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | MIA | ||||||||
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| Credential: | N.P.,RNC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 IRVING DR | ||||||||
| Address2: | |||||||||
| City: | SAN ANSELMO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949601065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4157212468 | ||||||||
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| Practice Location | |||||||||
| Address1: | 350 BON AIR CTR STE 200 | ||||||||
| Address2: | |||||||||
| City: | GREENBRAE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4155783095 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2007 | ||||||||
| LastUpdateDate: | 05/14/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WW0101X | RN395738 | CA | N | Nursing Service Providers | Registered Nurse | Women's Health Care, Ambulatory | 363LA2200X | 395738 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.