Provider Demographics
NPI:1851731228
Name:OBERSCHLAKE, MICHAELENA JO
Entity Type:Individual
Prefix:
First Name:MICHAELENA
Middle Name:JO
Last Name:OBERSCHLAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHAELENA
Other - Middle Name:JO
Other - Last Name:CARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1019 ANN ST
Mailing Address - Street 2:APT. D3
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2262
Mailing Address - Country:US
Mailing Address - Phone:770-335-7941
Mailing Address - Fax:
Practice Address - Street 1:1019 ANN ST
Practice Address - Street 2:APT D3
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2262
Practice Address - Country:US
Practice Address - Phone:770-335-7941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic