Healthcare Provider Details

I. General information

NPI: 1346159514
Provider Name (Legal Business Name): HOLLY J MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 E HOADLEY ST
KINGSFORD MI
49802-6301
US

IV. Provider business mailing address

195 E HOADLEY ST
KINGSFORD MI
49802-6301
US

V. Phone/Fax

Practice location:
  • Phone: 906-774-3300
  • Fax:
Mailing address:
  • Phone: 906-774-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number4704305616
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: