Provider Demographics
NPI:1871788570
Name:MITAS, ROCHELLE NELL (ACNP-C)
Entity type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:NELL
Last Name:MITAS
Suffix:
Gender:F
Credentials:ACNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 W MITCHELL ST
Mailing Address - Street 2:SUITE #400
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2275
Mailing Address - Country:US
Mailing Address - Phone:231-487-2490
Mailing Address - Fax:231-487-6055
Practice Address - Street 1:560 W MITCHELL ST
Practice Address - Street 2:SUITE #400
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2275
Practice Address - Country:US
Practice Address - Phone:231-487-2490
Practice Address - Fax:231-487-6055
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704212985363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care