Healthcare Provider Details

I. General information

NPI: 1104032580
Provider Name (Legal Business Name): MICHAEL LEE SLATER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 HOSPITAL DR
DOVER OH
44622-2058
US

IV. Provider business mailing address

201 HOSPITAL DR
DOVER OH
44622-2058
US

V. Phone/Fax

Practice location:
  • Phone: 330-343-6631
  • Fax: 330-343-8188
Mailing address:
  • Phone: 330-343-6631
  • Fax: 330-343-8188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN. 200776
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: