Provider Demographics
NPI:1508012089
Name:MITCHELL, MONTI MELISSA (LPN)
Entity Type:Individual
Prefix:
First Name:MONTI
Middle Name:MELISSA
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 1:620 SOUTH GALLATIN ROAD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-4013
Mailing Address - Country:US
Mailing Address - Phone:615-460-4300
Mailing Address - Fax:615-460-4301
Practice Address - Street 1:620 SOUTH GALLATIN ROAD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-4013
Practice Address - Country:US
Practice Address - Phone:615-460-4300
Practice Address - Fax:615-460-4301
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN69472164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse