Provider Demographics
NPI:1922767375
Name:MITCHELL, QUINTELLA NICOLE
Entity Type:Individual
Prefix:
First Name:QUINTELLA
Middle Name:NICOLE
Last Name:MITCHELL
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 1:4681 SOUTHAIRE DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-6123
Mailing Address - Country:US
Mailing Address - Phone:740-244-9613
Mailing Address - Fax:
Practice Address - Street 1:4681 SOUTHAIRE DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-6123
Practice Address - Country:US
Practice Address - Phone:740-244-9613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi
No172A00000XOther Service ProvidersDriverGroup - Single Specialty