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1194168807
MICHAEL SHANE MITCHELL
CAMP LEJEUNE, NC
NPI
1194168807
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
1710I1002X Military Health Care Provider, Independent Duty Corpsman
Enumeration Date
2013-04-11
Last Update Date
2013-04-11
Business Address
-- MICHAEL SHANE MITCHELL IDC
5371 WASHINGTON ST
CAMP LEJEUNE, NC 28547-1104
Phone number: 843-640-2075
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Mailing Address
-- MICHAEL SHANE MITCHELL IDC
5371 WASHINGTON ST
CAMP LEJEUNE, NC 28547-1104
Phone number: 843-640-2075
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