Provider Demographics
NPI:1447314695
Name:MITCHELL, MARTHA MINIHAN (RNC MS CAPT NC USNR)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:MINIHAN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RNC MS CAPT NC USNR
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:
Other - Last Name:MINIHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:STONINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06378-1450
Mailing Address - Country:US
Mailing Address - Phone:860-535-3078
Mailing Address - Fax:860-535-2806
Practice Address - Street 1:789 HOWARD AVENUE
Practice Address - Street 2:YALE NEW HAVEN HOSPITAL WOMENS CENTER
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519
Practice Address - Country:US
Practice Address - Phone:203-688-4101
Practice Address - Fax:203-688-1101
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002646363L00000X
NYF4205041363L00000X
MA96313364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Not Answered364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist