Provider Demographics
NPI:1194383141
Name:MITCHELL, DOROTHY MARIE (LSA, CSFA, CST)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:MARIE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LSA, CSFA, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 235
Mailing Address - Street 2:
Mailing Address - City:NEW WAVERLY
Mailing Address - State:TX
Mailing Address - Zip Code:77358-0235
Mailing Address - Country:US
Mailing Address - Phone:936-337-3565
Mailing Address - Fax:210-750-1361
Practice Address - Street 1:125 STATE HWY 150 W
Practice Address - Street 2:SUITE C-2
Practice Address - City:NEW WAVERLY
Practice Address - State:TX
Practice Address - Zip Code:77358
Practice Address - Country:US
Practice Address - Phone:936-337-3565
Practice Address - Fax:210-750-1361
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant