Deitra T Mixer

NPI #1053635755 in Cane Ridge, Tennessee

Provider Information

NPI Number: 1053635755
Entity Type: Individual
Name: Deitra T Mixer
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Specialist
Enumeration Date: Mar 24, 2010
Last Updated: Mar 24, 2010

Practice Location

Address: 8221 LENOX CREEKSIDE DR UNIT 7
City: Cane Ridge
State: Tennessee
ZIP Code: 37013-4657
Phone: (615) 417-3321

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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