Provider Demographics
NPI:1891118311
Name:MITCHELL, CHARMAYNE (DIRECTOR)
Entity Type:Individual
Prefix:
First Name:CHARMAYNE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:DIRECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 63 BOX 225
Mailing Address - Street 2:2 MILES WEST OF HWY87 MP 372
Mailing Address - City:WINSLOW
Mailing Address - State:AZ
Mailing Address - Zip Code:86047-9456
Mailing Address - Country:US
Mailing Address - Phone:928-419-0794
Mailing Address - Fax:928-585-1100
Practice Address - Street 1:HC 63 BOX 471
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:AZ
Practice Address - Zip Code:86047-9456
Practice Address - Country:US
Practice Address - Phone:928-863-6162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)