Provider Demographics
NPI:1649039488
Name:ELLISON, MICHELE MARIE
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:MARIE
Last Name:ELLISON
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 1:564 HEATHER LN
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-2334
Mailing Address - Country:US
Mailing Address - Phone:216-315-7915
Mailing Address - Fax:
Practice Address - Street 1:564 HEATHER LN
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-2334
Practice Address - Country:US
Practice Address - Phone:216-315-7915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider