Provider Demographics
NPI:1679887913
Name:MITCHELL, LAURIE A (LAC)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 THISTLE ST
Mailing Address - Street 2:
Mailing Address - City:BELLONA
Mailing Address - State:NY
Mailing Address - Zip Code:14415-9703
Mailing Address - Country:US
Mailing Address - Phone:315-729-1785
Mailing Address - Fax:585-526-1095
Practice Address - Street 1:360 PARRISH ST
Practice Address - Street 2:THOMPSON PROFESSIONAL BUILDING
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1789
Practice Address - Country:US
Practice Address - Phone:585-396-6679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25004385171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist