Healthcare Provider Details

I. General information

NPI: 1710807813
Provider Name (Legal Business Name): MICHELLE MISLOS LEE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 E DOROTHY LN
KETTERING OH
45420-1176
US

IV. Provider business mailing address

2115 E DOROTHY LN
KETTERING OH
45420-1176
US

V. Phone/Fax

Practice location:
  • Phone: 937-610-9175
  • Fax:
Mailing address:
  • Phone: 937-610-9174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0042849
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: