Provider Demographics
NPI:1376584938
Name:CHAFFEE, MICHELLE M (STNA/CNA)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:M
Last Name:CHAFFEE
Suffix:
Gender:F
Credentials:STNA/CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5872 MALLARD CT
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-1884
Mailing Address - Country:US
Mailing Address - Phone:440-257-1966
Mailing Address - Fax:
Practice Address - Street 1:5872 MALLARD CT
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-1884
Practice Address - Country:US
Practice Address - Phone:440-257-1966
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2216177Medicaid