Provider Demographics
NPI:1326647058
Name:MITCHELL, TAMIKA NICOLE
Entity Type:Individual
Prefix:
First Name:TAMIKA
Middle Name:NICOLE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 GRADOLPH ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-1420
Mailing Address - Country:US
Mailing Address - Phone:419-908-0634
Mailing Address - Fax:
Practice Address - Street 1:130 GRADOLPH ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-1420
Practice Address - Country:US
Practice Address - Phone:419-908-0634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant