Individual provider · Type 1 NPI

Mimzy Vanessa Bohannon

Licensed Practical Nurse · Mishawaka, IN

NPI number 1912692807 Active

Practice location

1540 Trinity Pl
Mishawaka, IN 46545-5006

Fax (574) 272-9298

Specialties and licenses

TaxonomyCodeLicense
Licensed Practical Nurse Primary 164W00000X27067174A (IN)

Licensed Practical Nurse: An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

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About NPI 1912692807

Mimzy Vanessa Bohannon's National Provider Identifier is 1912692807, issued on Apr 7, 2023. The primary taxonomy on file is Licensed Practical Nurse (164W00000X), and the practice location is in Mishawaka, IN. The record was last updated on Apr 7, 2023.