Provider Demographics
NPI:1972719060
Name:HUPP, MICHELE L
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:L
Last Name:HUPP
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 1:542 E MOHAWK DR
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:OH
Mailing Address - Zip Code:44644-9505
Mailing Address - Country:US
Mailing Address - Phone:330-863-0524
Mailing Address - Fax:
Practice Address - Street 1:542 E MOHAWK DR
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:OH
Practice Address - Zip Code:44644-9505
Practice Address - Country:US
Practice Address - Phone:330-863-0524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN047793164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse