| Doctor Name: | DIANE E MITCHELL |
| NPI Number: | 1134493224 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP-C |
| License Number: | 0024169890 |
| Business Practice Address: | 12825 Minnieville Road St 202 Lake Ridge, VA - 22192 |
| Business Phone Number: | 7037802800 |
| Business Fax Number: | 7037800461 |
| Mailing Address: | 8988 Lorton Station Blvd, LORTON |
| State: | VA |
| Postal Code: | 220794756 |
| Phone Number: | 7037802800 |
| Fax Number: | 7037800461 |
| NPI Enumeration Date: | 03/07/2012 |
| NPI Last Update Date: | 06/21/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 0024169890 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |