Provider Demographics
NPI:1568062768
Name:SMALL, MICHELE
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:SMALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7143 GALE RD SW
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:OH
Mailing Address - Zip Code:43025-9773
Mailing Address - Country:US
Mailing Address - Phone:740-919-4915
Mailing Address - Fax:
Practice Address - Street 1:7143 GALE RD SW
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:OH
Practice Address - Zip Code:43025-9773
Practice Address - Country:US
Practice Address - Phone:740-919-4915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker