Healthcare Provider Details

I. General information

NPI: 1831738657
Provider Name (Legal Business Name): WILLIAM K MITCHELL V DNP, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2019
Last Update Date: 12/26/2019
Certification Date: 12/26/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 E US-6 FRONTAGE RD
VALPARAISO IN
46385
US

IV. Provider business mailing address

508 KILLARNEY LN
VALPARAISO IN
46385-5498
US

V. Phone/Fax

Practice location:
  • Phone: 219-983-8300
  • Fax:
Mailing address:
  • Phone: 219-688-9535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28195790A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: