| NPI | 1740338359 |
|---|---|
| Former Name | TERESE A MITCHELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 0436612) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 47982-020) |
| 207Q00000X Family Medicine (Licence: MO 2013026055) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2016-10-03 |