Provider Demographics
NPI:1225790660
Name:MITCHELL, STACY LYNN (RN, MSN)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 1/2 AVONDALE AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-8303
Mailing Address - Country:US
Mailing Address - Phone:419-392-8133
Mailing Address - Fax:
Practice Address - Street 1:655 1/2 AVONDALE AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-8303
Practice Address - Country:US
Practice Address - Phone:419-392-8133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN243933163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health