Healthcare Provider Details

I. General information

NPI: 1013729250
Provider Name (Legal Business Name): MILLICENT MICHO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3188 BELLEVUE AVE
CINCINNATI OH
45219-2369
US

IV. Provider business mailing address

132 VAN VOAST AVE
BELLEVUE KY
41073-1025
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-7333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.541617
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: