MEDICARE: MRS. NITOSHIA MITCHELL HAIR LOSS SPECIALIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1744P3200X	Prosthetics Case Management		TX

General Provider Information

NPI Number	:	1043752884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NITOSHIA MITCHELL HAIR LOSS SPECIALIST

Provider Business Mailing Address
First Line	:	3709 N 20TH ST
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76708-2021
Country	:	US
Telephone Number	:	254-744-8242
Fax Number	:

Provider Business Practice Location Address
First Line	:	3709 N 20TH ST
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76708-2021
Country	:	US
Telephone Number	:	254-744-8242
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2016
Last Update Date	:	02/07/2022

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