Basic Information
| Provider Information | |||||||||
| NPI: | 1952593709 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MITCHELL | ||||||||
| FirstName: | JUDITH | ||||||||
| MiddleName: | MARIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2525 WEDGEWOOD DR | ||||||||
| Address2: | APT 500 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307844488 | ||||||||
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| Practice Location | |||||||||
| Address1: | 65 COMMUNITY ROAD | ||||||||
| Address2: | PIONEER PHYSICIANS NETWORD | ||||||||
| City: | TALLMADGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306336601 | ||||||||
| FaxNumber: | 3306302941 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2007 | ||||||||
| LastUpdateDate: | 08/15/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 374U00000X | Y | Nursing Service Related Providers | Home Health Aide |
ID Information
| ID | Type | State | Issuer | Description | 2405516 | 05 | OH | MEDICAID |