Provider Demographics
NPI:1134527336
Name:PRUCHNICKI, MICHELLE (LPN)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:PRUCHNICKI
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 1:324 E MAIN ST APT D
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-9335
Mailing Address - Country:US
Mailing Address - Phone:419-239-7986
Mailing Address - Fax:
Practice Address - Street 1:324 E MAIN ST APT D
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-9335
Practice Address - Country:US
Practice Address - Phone:419-239-7986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-21
Last Update Date:2014-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.146377-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse