MEDICARE: LYNETTE MITZEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1306581228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNETTE MITZEL

Provider Business Mailing Address
First Line	:	1200 E WASHINGTON ST
Second Line	:
City	:	WEST POINT
State	:	NE
Zip	:	68788-2505
Country	:	US
Telephone Number	:	402-372-5507
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 E WASHINGTON ST
Second Line	:
City	:	WEST POINT
State	:	NE
Zip	:	68788-2505
Country	:	US
Telephone Number	:	402-372-5507
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2022
Last Update Date	:	05/04/2022

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Directions to “ LYNETTE MITZEL ” Practice Location

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