Individual
ITALY MITCHELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10175 ENGLISH OAKS DR, KEITHVILLE, LA 71047-7561
(318) 317-8532
Mailing address
10175 ENGLISH OAKS DR, KEITHVILLE, LA 71047-7561
(318) 317-8532
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
010128014
LA
Other
Enumeration date
10/26/2020
Last updated
10/26/2020
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