Healthcare Provider Details

I. General information

NPI: 1043182041
Provider Name (Legal Business Name): DAEJHANEL MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41215 FOX RUN
NOVI MI
48377-4803
US

IV. Provider business mailing address

PO BOX 37022
OAK PARK MI
48237-0022
US

V. Phone/Fax

Practice location:
  • Phone: 248-513-7678
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704328817
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: