Provider Demographics
NPI:1770551830
Name:NOFFKE, MICHELE RENE (LPN)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:RENE
Last Name:NOFFKE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:COPELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4692 ROSSWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-6911
Mailing Address - Country:US
Mailing Address - Phone:937-964-8281
Mailing Address - Fax:937-964-8552
Practice Address - Street 1:1311 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45506-1219
Practice Address - Country:US
Practice Address - Phone:937-360-4320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN087856164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2125695Medicaid