Provider Demographics
NPI:1851741250
Name:MIKKOLA, TAWANNA SHEREE
Entity Type:Individual
Prefix:
First Name:TAWANNA
Middle Name:SHEREE
Last Name:MIKKOLA
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 1:7615 NAREMORE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-4663
Mailing Address - Country:US
Mailing Address - Phone:832-329-0285
Mailing Address - Fax:
Practice Address - Street 1:7615 NAREMORE DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-4663
Practice Address - Country:US
Practice Address - Phone:832-329-0285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator