Provider Demographics
NPI:1689433609
Name:MITCHELL, DJO DENISE DIANE
Entity Type:Individual
Prefix:
First Name:DJO
Middle Name:DENISE DIANE
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 1:2845 JONES RD
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37771-3309
Mailing Address - Country:US
Mailing Address - Phone:901-652-9243
Mailing Address - Fax:
Practice Address - Street 1:2845 JONES RD
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37771-3309
Practice Address - Country:US
Practice Address - Phone:901-652-9243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN246552163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse