Provider Demographics
NPI:1013269125
Name:JOHN, MICHELLE
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:
Last Name:JOHN
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 1:35 ELM ST
Mailing Address - Street 2:A
Mailing Address - City:WHITELAND
Mailing Address - State:IN
Mailing Address - Zip Code:46184-4100
Mailing Address - Country:US
Mailing Address - Phone:317-469-8247
Mailing Address - Fax:
Practice Address - Street 1:35 ELM STREET
Practice Address - Street 2:APT A
Practice Address - City:WHITELAND
Practice Address - State:IN
Practice Address - Zip Code:46184
Practice Address - Country:US
Practice Address - Phone:317-469-8247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide