1851594477 NPI number — ANNA MARLENA WOJCICKA-MITCHELL M.D.

Table of content: ANNA MARLENA WOJCICKA-MITCHELL M.D. (NPI 1851594477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851594477 NPI number — ANNA MARLENA WOJCICKA-MITCHELL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOJCICKA-MITCHELL
Provider First Name:
ANNA
Provider Middle Name:
MARLENA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851594477
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3810
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOPLIN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64803-3810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-347-7300
Provider Business Mailing Address Fax Number:
417-347-7237

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1002 MCINTOSH CIR STE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOPLIN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64804-3600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-347-7300
Provider Business Practice Location Address Fax Number:
417-347-7237
Provider Enumeration Date:
06/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  2009006158 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1851594477 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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