Provider Demographics
NPI:1912290966
Name:WILLIAMS, MICHELE RAYE (LPN)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:RAYE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:RAYE
Other - Last Name:CALDERONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2339 S FREEDOM AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-5111
Mailing Address - Country:US
Mailing Address - Phone:330-323-8050
Mailing Address - Fax:
Practice Address - Street 1:2339 S FREEDOM AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-5111
Practice Address - Country:US
Practice Address - Phone:330-323-8050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-098015164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse