Provider Demographics
NPI:1750509642
Name:CAESAR, MICHELLE AIMEE (APRN)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:AIMEE
Last Name:CAESAR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MEDICAL CENTER DR STE A
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-2688
Mailing Address - Country:US
Mailing Address - Phone:937-523-9480
Mailing Address - Fax:937-523-9490
Practice Address - Street 1:200 MEDICAL CENTER DR STE A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-2688
Practice Address - Country:US
Practice Address - Phone:937-523-9480
Practice Address - Fax:937-523-9490
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH309419163W00000X
OHAPRN.CNP.17178363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0180984Medicaid
OHAPRN.CNP. 17178OtherSTATE LICENSE - OHIO
OH0180984Medicaid