Provider Demographics
NPI:1598205247
Name:MITCHELL, WENDY
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
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 1:10225 FULTON RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44645-9761
Mailing Address - Country:US
Mailing Address - Phone:330-600-4156
Mailing Address - Fax:
Practice Address - Street 1:5508 PINETREE DR
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-7452
Practice Address - Country:US
Practice Address - Phone:330-600-4156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-28
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH122438164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse