Provider Demographics
NPI:1932652922
Name:MIXON, JULIUS DEMICHAEL (RN)
Entity Type:Individual
Prefix:
First Name:JULIUS
Middle Name:DEMICHAEL
Last Name:MIXON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6439 GRACELAND AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-4405
Mailing Address - Country:US
Mailing Address - Phone:513-801-5116
Mailing Address - Fax:
Practice Address - Street 1:6439 GRACELAND AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-4405
Practice Address - Country:US
Practice Address - Phone:513-801-5116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.401500163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse