Provider Demographics
NPI:1467041806
Name:MITCHELL, ANTONIO E
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:E
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 COLUMBUS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-1605
Mailing Address - Country:US
Mailing Address - Phone:513-228-1489
Mailing Address - Fax:513-934-7173
Practice Address - Street 1:645 COLUMBUS AVE STE A
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1605
Practice Address - Country:US
Practice Address - Phone:513-228-1489
Practice Address - Fax:513-934-7173
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker