Provider Demographics
NPI:1629312731
Name:DIAL-KNOX, MICHAELLE (LPN)
Entity Type:Individual
Prefix:
First Name:MICHAELLE
Middle Name:
Last Name:DIAL-KNOX
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 1:12001 THORNWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-3815
Mailing Address - Country:US
Mailing Address - Phone:440-813-6123
Mailing Address - Fax:
Practice Address - Street 1:12001 THORNWOOD AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-3815
Practice Address - Country:US
Practice Address - Phone:440-813-6123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN105584164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse