Provider Demographics
NPI:1932463551
Name:KHOSLA, MICHELLE E (NP)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:E
Last Name:KHOSLA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10529 LOVELAND MADEIRA RD
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-8963
Mailing Address - Country:US
Mailing Address - Phone:513-256-2313
Mailing Address - Fax:
Practice Address - Street 1:6010 S MASON MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-3706
Practice Address - Country:US
Practice Address - Phone:513-246-7000
Practice Address - Fax:513-204-6355
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13372363L00000X
KY3008881363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner