Basic Information
| Provider Information | |||||||||
| NPI: | 1922209170 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MITCHELL | ||||||||
| FirstName: | SHELLEY | ||||||||
| MiddleName: | MILLER | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNA | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 POTRERO AVE # 3C38 | ||||||||
| Address2: | SFGH ANESTHESIA | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941103518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152068213 | ||||||||
| FaxNumber: | 4152066014 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 POTRERO AVE # 3C38 | ||||||||
| Address2: | SFGH ANESTHESIA | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941103518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152068213 | ||||||||
| FaxNumber: | 4152066014 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2007 | ||||||||
| LastUpdateDate: | 09/30/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WM0705X | RN512627 | CA | N | Nursing Service Providers | Registered Nurse | Medical-Surgical | 367500000X | CRNA3201 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 107359 | 01 | SFGH INTERNAL USE ONLY-COMMERCIAL NUMBER | OTHER |