Provider Demographics
NPI:1457180200
Name:MITCHELL, IJAUH
Entity type:Individual
Prefix:
First Name:IJAUH
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18169 PINE W BLDG 34
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48193-8316
Mailing Address - Country:US
Mailing Address - Phone:734-629-3495
Mailing Address - Fax:
Practice Address - Street 1:25881 MAPLE DR
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-9313
Practice Address - Country:US
Practice Address - Phone:313-898-4455
Practice Address - Fax:313-406-6149
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider