Provider Demographics
NPI:1013022250
Name:MITCHELL, DENNA (RN)
Entity Type:Individual
Prefix:
First Name:DENNA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-2623
Mailing Address - Country:US
Mailing Address - Phone:618-393-7732
Mailing Address - Fax:618-395-3123
Practice Address - Street 1:905 E MAIN ST
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-2623
Practice Address - Country:US
Practice Address - Phone:618-393-7732
Practice Address - Fax:618-395-3123
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL41226305163WP0200X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL8030288OtherBLUECROSS/BLUESHIELD IL