Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 2067 | NE |
NPI | 1013131952 |
---|---|
Provider Name | Misty M Mitchell |
First Address | Omaha, NE 68117-2320 |
Second Address | Omaha, NE 68138 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 08/07/2007 |