Provider Demographics
NPI:1366027344
Name:MITCHELL, ANA MARIA V (LAC)
Entity Type:Individual
Prefix:
First Name:ANA MARIA
Middle Name:V
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:ANA MARIA
Other - Middle Name:
Other - Last Name:VADILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:742 W BITTERSWEET PL APT 1W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-6576
Mailing Address - Country:US
Mailing Address - Phone:917-615-9991
Mailing Address - Fax:
Practice Address - Street 1:522 POPLAR DR
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2717
Practice Address - Country:US
Practice Address - Phone:847-251-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198-001549171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist