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NPI Code Detail

MEDICARE: MADDIE LEE MITCHELL

MEDICARE: MADDIE LEE MITCHELL
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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1457165474
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADDIE LEE MITCHELL
Provider Business Mailing Address
First Line : 2480 KIM ST NE
Second Line :
City : HARTVILLE
State : OH
Zip : 44632-8637
Country : US
Telephone Number : 330-904-7856
Fax Number :
Provider Business Practice Location Address
First Line : 1972 CLARK AVE
Second Line :
City : ALLIANCE
State : OH
Zip : 44601-3993
Country : US
Telephone Number : 330-821-5320
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2025
Last Update Date : 02/03/2025

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Directions to “ MADDIE LEE MITCHELL ” Practice Location

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