Healthcare Provider Details

I. General information

NPI: 1326852443
Provider Name (Legal Business Name): JENISE ANN MIZELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1836 MORNINGSIDE DR
LINCOLN NE
68506-2338
US

IV. Provider business mailing address

4721 DUXHALL DR
LINCOLN NE
68516-3116
US

V. Phone/Fax

Practice location:
  • Phone: 402-525-6191
  • Fax:
Mailing address:
  • Phone: 402-525-6191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: