Provider Demographics
NPI:1952593709
Name:MITCHELL, JUDITH MARIE
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:MARIE
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 1:2525 WEDGEWOOD DR
Mailing Address - Street 2:APT 500
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312
Mailing Address - Country:US
Mailing Address - Phone:330-784-4488
Mailing Address - Fax:
Practice Address - Street 1:65 COMMUNITY ROAD
Practice Address - Street 2:PIONEER PHYSICIANS NETWORD
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278
Practice Address - Country:US
Practice Address - Phone:330-633-6601
Practice Address - Fax:330-630-2941
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2405516Medicaid
OH2405516Medicaid