Provider Demographics
NPI:1578868279
Name:NUSBAUM, MEKKA MICHELLE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:MEKKA
Middle Name:MICHELLE
Last Name:NUSBAUM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6444 SAUTERNE DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-5283
Mailing Address - Country:US
Mailing Address - Phone:513-330-6886
Mailing Address - Fax:
Practice Address - Street 1:6444 SAUTERNE DR
Practice Address - Street 2:
Practice Address - City:LIBERTY TWP
Practice Address - State:OH
Practice Address - Zip Code:45011-5283
Practice Address - Country:US
Practice Address - Phone:513-330-6886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH141364164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse