Provider Demographics
NPI:1063652360
Name:MCELFRESH, ANNIE MICHELLE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:MICHELLE
Last Name:MCELFRESH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10955 VALENTINE RD SW
Mailing Address - Street 2:
Mailing Address - City:STOUTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43154-9509
Mailing Address - Country:US
Mailing Address - Phone:740-477-6002
Mailing Address - Fax:740-477-6002
Practice Address - Street 1:11520 DOZER RD SW
Practice Address - Street 2:
Practice Address - City:STOUTSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43154-9732
Practice Address - Country:US
Practice Address - Phone:740-207-6105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.125299164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse