Provider Demographics
NPI:1568645224
Name:PUGH, LETHA MICHELLE (RN)
Entity Type:Individual
Prefix:MS
First Name:LETHA
Middle Name:MICHELLE
Last Name:PUGH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 WILTSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-2431
Mailing Address - Country:US
Mailing Address - Phone:614-596-4136
Mailing Address - Fax:
Practice Address - Street 1:651 WILTSHIRE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-2431
Practice Address - Country:US
Practice Address - Phone:614-596-4136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN298537163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2346107Medicaid