Provider Demographics
NPI:1134721103
Name:MITCHELL, JEFFERY LEVI
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:LEVI
Last Name:MITCHELL
Suffix:
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 1:63149 SIVERLY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MC ARTHUR
Mailing Address - State:OH
Mailing Address - Zip Code:45651-8965
Mailing Address - Country:US
Mailing Address - Phone:440-522-9605
Mailing Address - Fax:
Practice Address - Street 1:63149 SIVERLY CREEK RD
Practice Address - Street 2:
Practice Address - City:MC ARTHUR
Practice Address - State:OH
Practice Address - Zip Code:45651-8965
Practice Address - Country:US
Practice Address - Phone:440-522-9605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker