Provider Demographics
NPI:1326611500
Name:MITCHELL, RECITA CARNELLA (PHLEBOTOMIST)
Entity Type:Individual
Prefix:MISS
First Name:RECITA
Middle Name:CARNELLA
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5419 LILIAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63120-2322
Mailing Address - Country:US
Mailing Address - Phone:314-728-2800
Mailing Address - Fax:
Practice Address - Street 1:5419 LILIAN AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63120-2322
Practice Address - Country:US
Practice Address - Phone:314-728-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOG9Z6F7T3251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health