Basic Information
| Provider Information | |||||||||
| NPI: | 1861617201 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MITCHELL | ||||||||
| FirstName: | ROXANN | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 253 | ||||||||
| Address2: | |||||||||
| City: | BUDD LAKE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078280253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9085091801 | ||||||||
| FaxNumber: | 7323019252 | ||||||||
| Practice Location | |||||||||
| Address1: | 57 US HIGHWAY 46 | ||||||||
| Address2: | |||||||||
| City: | HACKETTSTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078402695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9085091801 | ||||||||
| FaxNumber: | 7323019252 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2007 | ||||||||
| LastUpdateDate: | 09/10/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 176B00000X | 25ME00024900 | NJ | Y | Other Service Providers | Midwife |
No ID Information.