Provider Demographics
NPI:1053804757
Name:MITCHELL, NIA
Entity type:Individual
Prefix:MS
First Name:NIA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 W AIRLINE HWY STE F
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-3710
Mailing Address - Country:US
Mailing Address - Phone:504-603-0273
Mailing Address - Fax:985-359-6537
Practice Address - Street 1:1317 W AIRLINE HWY STE F
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-3710
Practice Address - Country:US
Practice Address - Phone:504-603-0273
Practice Address - Fax:985-359-6537
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator