Healthcare Provider Details

I. General information

NPI: 1407384894
Provider Name (Legal Business Name): CARMEN M MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 05/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 W MONROE ST STE 600
JACKSON MI
49202-2083
US

IV. Provider business mailing address

950 W MONROE ST STE 600
JACKSON MI
49202-2083
US

V. Phone/Fax

Practice location:
  • Phone: 517-945-5632
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: