Provider Demographics
NPI:1477031052
Name:PAULDON, MICHELLE (INCORPORATION)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:PAULDON
Suffix:
Gender:F
Credentials:INCORPORATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5377 MAYFLOWER CT
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-3861
Mailing Address - Country:US
Mailing Address - Phone:224-324-8355
Mailing Address - Fax:
Practice Address - Street 1:5377 MAYFLOWER CT
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-3861
Practice Address - Country:US
Practice Address - Phone:224-324-8355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-05
Last Update Date:2018-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide