Provider Demographics
NPI:1013604735
Name:MIXON-CUMMINGS, MICHELLE LERAE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LERAE
Last Name:MIXON-CUMMINGS
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 1:5512 MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-3316
Mailing Address - Country:US
Mailing Address - Phone:440-789-3286
Mailing Address - Fax:
Practice Address - Street 1:5512 MORGAN ST
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-3316
Practice Address - Country:US
Practice Address - Phone:440-789-3286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No172A00000XOther Service ProvidersDriver
No376J00000XNursing Service Related ProvidersHomemaker