Provider Demographics
NPI:1639063118
Name:MITCHELL, QWANISHA REYANA
Entity type:Individual
Prefix:
First Name:QWANISHA
Middle Name:REYANA
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 1:3231 N 40TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-3021
Mailing Address - Country:US
Mailing Address - Phone:402-708-6218
Mailing Address - Fax:
Practice Address - Street 1:11635 ARBOR ST STE 110
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5000
Practice Address - Country:US
Practice Address - Phone:402-506-9368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-07
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide