Provider Demographics
NPI:1275008690
Name:WILLIAMS, MICHELLE (INDEPENDENT PROVIDER)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:INDEPENDENT PROVIDER
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:INDEPENDENT PROVIDER
Mailing Address - Street 1:5524 DELORA AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44144-4133
Mailing Address - Country:US
Mailing Address - Phone:216-906-5309
Mailing Address - Fax:
Practice Address - Street 1:5524 DELORA AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44144-4133
Practice Address - Country:US
Practice Address - Phone:216-906-5309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH379279850900376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0195511Medicaid
OH379279850900OtherNURSE AIDE PROGRAM