Provider Demographics
NPI:1770327785
Name:PETERSON, MICHELLE (HEALTH AID)
Entity type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:HEALTH AID
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HOME HEALTH AID
Mailing Address - Street 1:3317 E STROOP RD APT 202
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-1363
Mailing Address - Country:US
Mailing Address - Phone:937-248-6392
Mailing Address - Fax:
Practice Address - Street 1:3317 E STROOP RD APT 202
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-1363
Practice Address - Country:US
Practice Address - Phone:937-248-6392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide