Provider Demographics
NPI:1790366839
Name:MITCHELL, MERCEDES CLINET (MA)
Entity Type:Individual
Prefix:MS
First Name:MERCEDES
Middle Name:CLINET
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1456 PINEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-4064
Mailing Address - Country:US
Mailing Address - Phone:419-973-7799
Mailing Address - Fax:
Practice Address - Street 1:1456 PINEWOOD AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43607-4064
Practice Address - Country:US
Practice Address - Phone:419-973-7799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3654155374U00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251E00000XAgenciesHome Health