Healthcare Provider Details

I. General information

NPI: 1013349133
Provider Name (Legal Business Name): MICHELE TERESA JOHNSON STNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27000 ZEMAN AVE.
EUCLID OH
44132-0425
US

IV. Provider business mailing address

27000 ZEMAN AVE. P.O.BOX 32425
EUCLID OH
44132-0425
US

V. Phone/Fax

Practice location:
  • Phone: 216-731-1162
  • Fax:
Mailing address:
  • Phone: 216-731-1162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number401443120912
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: