Healthcare Provider Details

I. General information

NPI: 1750509642
Provider Name (Legal Business Name): MICHELLE AIMEE CAESAR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL CENTER DR STE A
SPRINGFIELD OH
45504-2688
US

IV. Provider business mailing address

200 MEDICAL CENTER DR STE A
SPRINGFIELD OH
45504-2688
US

V. Phone/Fax

Practice location:
  • Phone: 937-523-9480
  • Fax: 937-523-9490
Mailing address:
  • Phone: 937-523-9480
  • Fax: 937-523-9490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number309419
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.17178
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: