MEDICARE: MS. YAVONNE M MITCHELL- MONEY B.S,BOCCP

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	174400000X	Specialist	C22289	SC

General Provider Information

NPI Number	:	1114930443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. YAVONNE M MITCHELL- MONEY B.S,BOCCP

Provider Business Mailing Address
First Line	:	525 E JEFFERSON AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48226-4324
Country	:	US
Telephone Number	:	313-965-7884
Fax Number	:	313-965-7885

Provider Business Practice Location Address
First Line	:	525 E JEFFERSON AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48226-4324
Country	:	US
Telephone Number	:	313-965-7884
Fax Number	:

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	04/27/2012

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