Provider Demographics
NPI:1841791365
Name:MITCHELL, SHIRLEY ILENE (LVN)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:ILENE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 163
Mailing Address - Street 2:
Mailing Address - City:HEMPHILL
Mailing Address - State:TX
Mailing Address - Zip Code:75948-0163
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:194 STRICKLAND XING E
Practice Address - Street 2:
Practice Address - City:PINELAND
Practice Address - State:TX
Practice Address - Zip Code:75968
Practice Address - Country:US
Practice Address - Phone:409-594-4980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX315774164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse