Individual provider Active NPI

Judy Arlene Mitzel, L.P.N.

  • Licensed Practical Nurse
  • Carrollton, OH
National Provider Identifier
1386894111
Registry record updated Sep 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
PN.081426 MEDS Issued in OH
Practice address
1051 Montero Rd NE
Carrollton, OH 44615-9165
Phone
(330) 738-5110
NPI assigned
Sep 29, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 29, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X PN.081426 MEDS OH Primary

Addresses

Primary practice location

1051 Montero Rd NE
Carrollton, OH 44615-9165

Mailing address

1051 Montero Rd NE
Carrollton, OH 44615-9165
Phone (330) 738-5110

Other identifiers 1

IdentifierTypeStateIssuer
2661043MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PN.081426 MEDSOHMDLicensed Practical Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222646400000",
    "number": "1386894111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1051 MONTERO RD NE",
            "city": "CARROLLTON",
            "state": "OH",
            "postal_code": "446159165",
            "telephone_number": "330-738-5110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1051 MONTERO RD NE",
            "city": "CARROLLTON",
            "state": "OH",
            "postal_code": "446159165",
            "telephone_number": "330-738-5110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITZEL",
        "first_name": "JUDY",
        "middle_name": "ARLENE",
        "name_prefix": "Mrs.",
        "credential": "L.P.N.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-09-29",
        "last_updated": "2008-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "PN.081426 MEDS",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2661043",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carrollton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.