Provider Demographics
NPI:1811026230
Name:MULKINS, MICHELLE
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:MULKINS
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 1:6610 LEAR NAGLE RD
Mailing Address - Street 2:LOT 20
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-3261
Mailing Address - Country:US
Mailing Address - Phone:440-327-5902
Mailing Address - Fax:
Practice Address - Street 1:6610 LEAR NAGLE RD
Practice Address - Street 2:LOT 20
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-3261
Practice Address - Country:US
Practice Address - Phone:440-327-5902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2687883Medicaid