Provider Demographics
NPI:1164545075
Name:MITCHELL, MARY MAE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MAE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 116
Mailing Address - Street 2:300 VAN HYDE STREET
Mailing Address - City:NEW STRAITSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43766-0116
Mailing Address - Country:US
Mailing Address - Phone:740-394-2930
Mailing Address - Fax:
Practice Address - Street 1:300 VAN HYDE ST.
Practice Address - Street 2:
Practice Address - City:NEW STRAITSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43766
Practice Address - Country:US
Practice Address - Phone:740-394-2930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.086182164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse