Healthcare Provider Details

I. General information

NPI: 1346144243
Provider Name (Legal Business Name): MICHELLE ILIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2770 CENTENNIAL RD BLDG 7
TOLEDO OH
43617-1829
US

IV. Provider business mailing address

5667 APPALOOSA CIR
MORROW OH
45152-8283
US

V. Phone/Fax

Practice location:
  • Phone: 419-794-0567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704398271
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0043379
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: