MEDICARE: MITCHELL WILSON CNP

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	363LA2200X	Adult Health Nurse Practitioner	APRN.CNP.0037106	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154159341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL WILSON CNP

Provider Business Mailing Address
First Line	:	5885 HARRISON AVE STE 3500
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45248-1739
Country	:	US
Telephone Number	:	513-922-9660
Fax Number	:	513-347-2347

Provider Business Practice Location Address
First Line	:	5885 HARRISON AVE STE 3500
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45248-1739
Country	:	US
Telephone Number	:	513-922-9660
Fax Number	:	513-347-2347

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

Provider Enumeration Date	:	07/22/2024
Last Update Date	:	12/04/2024

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