Provider Demographics
NPI:1164073797
Name:ABBOTT, LAMICHELLE SIMONE
Entity Type:Individual
Prefix:
First Name:LAMICHELLE
Middle Name:SIMONE
Last Name:ABBOTT
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 1:2594 LAKE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-7323
Mailing Address - Country:US
Mailing Address - Phone:216-407-1070
Mailing Address - Fax:
Practice Address - Street 1:2594 LAKE POINTE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-7323
Practice Address - Country:US
Practice Address - Phone:216-407-1070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH429103163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse