Provider Demographics
NPI:1962849356
Name:DIMICHELE, MELISSA A (LPN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:DIMICHELE
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 1:713 CEDAR DR
Mailing Address - Street 2:APT 16
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-4897
Mailing Address - Country:US
Mailing Address - Phone:937-360-6490
Mailing Address - Fax:
Practice Address - Street 1:713 CEDAR DR
Practice Address - Street 2:APT 16
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-4897
Practice Address - Country:US
Practice Address - Phone:937-360-6490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-27
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN155556164W00000X
OH376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No376K00000XNursing Service Related ProvidersNurse's Aide