Provider Demographics
NPI:1679963763
Name:MITCHELL, JASMINE
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
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 1:1724 BIRCH RD
Mailing Address - Street 2:APT 203
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-4537
Mailing Address - Country:US
Mailing Address - Phone:262-748-7496
Mailing Address - Fax:
Practice Address - Street 1:1724 BIRCH RD
Practice Address - Street 2:APT 203
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-4537
Practice Address - Country:US
Practice Address - Phone:262-748-7496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI294499376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide