Provider Demographics
NPI:1194864413
Name:LUDSIN, MICHELLE L (MSN FNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:LUDSIN
Suffix:
Gender:F
Credentials:MSN FNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, FNP-BC
Mailing Address - Street 1:610 S PLUM ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-1630
Mailing Address - Country:US
Mailing Address - Phone:937-644-1920
Mailing Address - Fax:937-644-2024
Practice Address - Street 1:610 S PLUM ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-1630
Practice Address - Country:US
Practice Address - Phone:937-644-1920
Practice Address - Fax:937-644-2024
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.286140-COA1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3053047Medicaid