Healthcare Provider Details

I. General information

NPI: 1285977710
Provider Name (Legal Business Name): CHARLOTTE ASTRID VIVIENNE VONN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA RAE MITCHELL MD

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 LOOP RD
WINNSBORO LA
71295-3344
US

IV. Provider business mailing address

200 W 134TH PL
CUT OFF LA
70345-4143
US

V. Phone/Fax

Practice location:
  • Phone: 318-435-9411
  • Fax:
Mailing address:
  • Phone: 985-325-9333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.207500
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.207500
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: