Provider Demographics
NPI:1750019154
Name:MITCHELL, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
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 1:4700 BAKER RD
Mailing Address - Street 2:
Mailing Address - City:NEW MARSHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45766-9701
Mailing Address - Country:US
Mailing Address - Phone:740-649-2301
Mailing Address - Fax:
Practice Address - Street 1:88 N PLAINS RD
Practice Address - Street 2:
Practice Address - City:THE PLAINS
Practice Address - State:OH
Practice Address - Zip Code:45780-1162
Practice Address - Country:US
Practice Address - Phone:740-649-2301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH379361163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management