Provider Demographics
NPI:1942784194
Name:MITCHELL, RAYMOND W II
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:W
Last Name:MITCHELL
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 TAYLOR GLEN BLVD W
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-7015
Mailing Address - Country:US
Mailing Address - Phone:614-975-9843
Mailing Address - Fax:
Practice Address - Street 1:1107 TAYLOR GLEN BLVD W
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-7015
Practice Address - Country:US
Practice Address - Phone:614-975-9843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-23
Last Update Date:2018-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide