Provider Demographics
NPI:1538640222
Name:DEINES, MITCHELL E (RP)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:E
Last Name:DEINES
Suffix:
Gender:M
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 COURT ST
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-4085
Mailing Address - Country:US
Mailing Address - Phone:402-223-4779
Mailing Address - Fax:402-223-5610
Practice Address - Street 1:910 COURT ST
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-4085
Practice Address - Country:US
Practice Address - Phone:402-223-4779
Practice Address - Fax:402-223-5610
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10088183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026077200Medicaid