Healthcare Provider Details

I. General information

NPI: 1043114093
Provider Name (Legal Business Name): KATHY MITCHELL
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3291 GREENWICH ANGLING RD
GREENWICH OH
44837-9443
US

IV. Provider business mailing address

3291 GREENWICH ANGLING RD
GREENWICH OH
44837-9443
US

V. Phone/Fax

Practice location:
  • Phone: 419-752-5021
  • Fax:
Mailing address:
  • Phone: 419-752-5021
  • Fax: 419-752-8705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN-271774
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: