Provider Demographics
NPI:1629235866
Name:MITCHELL, NANA J
Entity Type:Individual
Prefix:MRS
First Name:NANA
Middle Name:J
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 1:3803 GREEN VALLEY RD
Mailing Address - Street 2:GREEN VALLEY MEDICAL COPY SERVICE
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9003
Mailing Address - Country:US
Mailing Address - Phone:812-941-1477
Mailing Address - Fax:812-948-6415
Practice Address - Street 1:3803 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9003
Practice Address - Country:US
Practice Address - Phone:812-941-1477
Practice Address - Fax:812-948-6415
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200522550AMedicaid