Provider Demographics
NPI:1518428796
Name:MITCHELL, TAMALA THERISE
Entity type:Individual
Prefix:
First Name:TAMALA
Middle Name:THERISE
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 1:236 WST.
Mailing Address - Street 2:#12 NW
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001
Mailing Address - Country:US
Mailing Address - Phone:202-704-6177
Mailing Address - Fax:
Practice Address - Street 1:1200 DELAWARE AVE SW APT 320
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-3945
Practice Address - Country:US
Practice Address - Phone:202-839-6698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1976OtherHEALTH AIDE