Healthcare Provider Details

I. General information

NPI: 1962200733
Provider Name (Legal Business Name): A'MIYAH WRENN-MITCHELL PCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6818 GROVER ST STE 101
OMAHA NE
68106-3632
US

IV. Provider business mailing address

6818 GROVER ST STE 101
OMAHA NE
68106-3632
US

V. Phone/Fax

Practice location:
  • Phone: 402-390-2492
  • Fax:
Mailing address:
  • Phone: 402-390-2492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: