Provider Demographics
NPI:1821342049
Name:MCCABE, MICHELLE LEE (LPN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:MCCABE
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 1:4400 CREEKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-5213
Mailing Address - Country:US
Mailing Address - Phone:513-571-6177
Mailing Address - Fax:
Practice Address - Street 1:4400 CREEKVIEW DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-5213
Practice Address - Country:US
Practice Address - Phone:513-571-6177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH123465164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH123465OtherOHIO BOARD OF NURSING