Healthcare Provider Details

I. General information

NPI: 1972006815
Provider Name (Legal Business Name): DEANNA LASHAWN MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2018
Last Update Date: 03/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 HARRISON AVE
AKRON OH
44314-2811
US

IV. Provider business mailing address

931 HARRISON AVE
AKRON OH
44314-2811
US

V. Phone/Fax

Practice location:
  • Phone: 330-422-9269
  • Fax:
Mailing address:
  • Phone: 330-422-9269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number0217779
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number401792980915
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: