Provider Demographics
NPI:1710018700
Name:KITTEL, MINNIA LOUISE
Entity Type:Individual
Prefix:MISS
First Name:MINNIA
Middle Name:LOUISE
Last Name:KITTEL
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 1:407 CLINTON ST
Mailing Address - Street 2:P.O. BOX 392
Mailing Address - City:MARTINS FERRY
Mailing Address - State:OH
Mailing Address - Zip Code:43935-1341
Mailing Address - Country:US
Mailing Address - Phone:740-359-9104
Mailing Address - Fax:
Practice Address - Street 1:407 CLINTON ST
Practice Address - Street 2:
Practice Address - City:MARTINS FERRY
Practice Address - State:OH
Practice Address - Zip Code:43935-1341
Practice Address - Country:US
Practice Address - Phone:740-359-9104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2447230374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2447230Medicaid