Healthcare Provider Details

I. General information

NPI: 1518683028
Provider Name (Legal Business Name): BONNIE DODD MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9070 PATRICKS GLEN LN
CINCINNATI OH
45242-7558
US

IV. Provider business mailing address

9070 PATRICKS GLEN LN
CINCINNATI OH
45242-7558
US

V. Phone/Fax

Practice location:
  • Phone: 513-368-2763
  • Fax:
Mailing address:
  • Phone: 513-368-2763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: