Provider Demographics
NPI:1558673855
Name:MITCHELL, MAGGIE YVONNE
Entity Type:Individual
Prefix:MRS
First Name:MAGGIE
Middle Name:YVONNE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6929 W HERBERT AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-2914
Mailing Address - Country:US
Mailing Address - Phone:414-461-0933
Mailing Address - Fax:414-461-4402
Practice Address - Street 1:6929 W HERBERT AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-2914
Practice Address - Country:US
Practice Address - Phone:414-461-0933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27762031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse