Healthcare Provider Details

I. General information

NPI: 1558235861
Provider Name (Legal Business Name): MRS. DONNA LEE MITCHEM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 BURLINGTON ST
HOLDREGE NE
68949-1705
US

IV. Provider business mailing address

1118 BURLINGTON ST
HOLDREGE NE
68949-1705
US

V. Phone/Fax

Practice location:
  • Phone: 308-995-3760
  • Fax:
Mailing address:
  • Phone: 308-708-0202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number82775
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: