Individual provider · NPI-1

Marshawn Mitchell Sr.

Clinic/Center · Buckeye, AZ

NPI number1104243500
StatusActive
Last updated in NPPESMar 24, 2014

Details

NPI
1104243500
Entity type
Individual (NPI-1)
Name
Marshawn Mitchell Sr.
Sex
Male
Sole proprietor
Yes
Enumeration date
Mar 24, 2014
Last updated
Mar 24, 2014

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261Q00000X Clinic/Center––Yes

Practice location

23605 W Bowker St
Buckeye, AZ 85326-7217

Phone 757-763-0754

Mailing address

23605 W Bowker St
Buckeye, AZ 85326-7217

Phone 757-763-0754

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