Provider Demographics
NPI:1760895288
Name:PLUMLEY, MICHELE LYNN
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:LYNN
Last Name:PLUMLEY
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 1:134 CHARLES CT
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-6022
Mailing Address - Country:US
Mailing Address - Phone:440-310-1165
Mailing Address - Fax:
Practice Address - Street 1:4854 ONEIL BLVD
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-2935
Practice Address - Country:US
Practice Address - Phone:440-233-4850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3088313374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3088313Medicaid