Provider Demographics
NPI:1508597147
Name:KOHLS, MITCHELL DEANNA
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:DEANNA
Last Name:KOHLS
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 1:36 GETCHELL ST
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-2238
Mailing Address - Country:US
Mailing Address - Phone:207-573-2936
Mailing Address - Fax:
Practice Address - Street 1:36 GETCHELL ST
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-2238
Practice Address - Country:US
Practice Address - Phone:207-735-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula