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General NPI Number Information
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NPI Number | 1174903942
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Entity Type | Individual
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Provider Name | MARK MITCHELL
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Gender | Male
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Dates
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Enumeration Date | 06/05/2015
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Last Update Date | 06/05/2015
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Provider Practice Location Address
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Address Line | 1108 MADISON PLZ STE 202
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City | CHESAPEAKE
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State | VA
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Zip | 23320-5166
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Country | US
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Telephone | 757-512-5565
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Fax | 757-644-5337
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Provider Business Mailing Address
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Address Line | 1108 MADISON PLZ STE 202
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City | CHESAPEAKE
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State | VA
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Zip | 23320-5166
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Country | US
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Telephone | 757-512-5565
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Fax | 757-644-5337
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 1510097
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License Number State | VA
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