Provider Demographics
NPI:1508312083
Name:ELLER, MICHAEL (LPN)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:ELLER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5123 CLOISTER DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-3901
Mailing Address - Country:US
Mailing Address - Phone:512-828-2528
Mailing Address - Fax:
Practice Address - Street 1:5123 CLOISTER DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-3901
Practice Address - Country:US
Practice Address - Phone:512-828-2528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLPN0000080742164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse