Provider Demographics
NPI:1023729324
Name:BRONNER, MICHELLE CAROL
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:CAROL
Last Name:BRONNER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:BRONNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:716 ANNAPOLIS AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-1604
Mailing Address - Country:US
Mailing Address - Phone:330-431-5999
Mailing Address - Fax:
Practice Address - Street 1:716 ANNAPOLIS AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-1604
Practice Address - Country:US
Practice Address - Phone:330-431-5999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRE650465253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care