Healthcare Provider Details

I. General information

NPI: 1598205247
Provider Name (Legal Business Name): WENDY MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5508 PINETREE DR
FORT PIERCE FL
34982-7452
US

IV. Provider business mailing address

10225 FULTON RD
MARSHALLVILLE OH
44645-9761
US

V. Phone/Fax

Practice location:
  • Phone: 330-600-4156
  • Fax:
Mailing address:
  • Phone: 330-600-4156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number122438
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: