Provider Demographics
NPI:1588464978
Name:MITCHELL, DEJAH
Entity type:Individual
Prefix:
First Name:DEJAH
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 S 24TH ST APT 210
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-2448
Mailing Address - Country:US
Mailing Address - Phone:402-979-3558
Mailing Address - Fax:
Practice Address - Street 1:12427 WEIR ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2127
Practice Address - Country:US
Practice Address - Phone:402-979-3558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-15
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion