Healthcare Provider Details

I. General information

NPI: 1528959210
Provider Name (Legal Business Name): GLENNA MITCHELL
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2025
Last Update Date: 07/11/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 SANDLICK BRANCH ROAD
BRUNO WV
25611
US

IV. Provider business mailing address

PO BOX 56
BRUNO WV
25611-0056
US

V. Phone/Fax

Practice location:
  • Phone: 304-946-0160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: