Healthcare Provider Details

I. General information

NPI: 1447879614
Provider Name (Legal Business Name): NEJIA MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4644 N 53RD ST
MILWAUKEE WI
53218-5011
US

IV. Provider business mailing address

4644 N 53RD ST
MILWAUKEE WI
53218-5011
US

V. Phone/Fax

Practice location:
  • Phone: 414-916-6567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: