Provider Demographics
NPI:1851594477
Name:WOJCICKA-MITCHELL, ANNA MARLENA (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARLENA
Last Name:WOJCICKA-MITCHELL
Suffix:
Gender:F
Credentials:MD
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 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-3810
Mailing Address - Country:US
Mailing Address - Phone:417-347-7300
Mailing Address - Fax:417-347-7237
Practice Address - Street 1:1905 W 32ND STREET, SUITE 403
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4312
Practice Address - Country:US
Practice Address - Phone:417-347-5500
Practice Address - Fax:417-347-8516
Is Sole Proprietor?:No
Enumeration Date:2007-06-10
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009006158174400000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1851594477Medicaid