Provider Information for 1326411745
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TYLISA MITCHELL
Sex: Female
NPI: 1326411745
Last Updated: 2015-11-06
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1326411745 | ||||||||
| Enumeration Date | 2015-11-06 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1100 LOGGER CT STE C100 RALEIGH, NC 27609-8525 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 1100 LOGGER CT STE C100 RALEIGH, NC 27609-8525 United States Phone: 919-844-7770 | Fax: | ||||||||
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