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General NPI Number Information
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NPI Number | 1023328499
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Entity Type | Individual
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Provider Name | MICHELLE NAKIESHA ELLIS LPN
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Gender | Female
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Dates
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Enumeration Date | 10/19/2010
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Last Update Date | 04/28/2017
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Provider Practice Location Address
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Address Line | 25110 TRYON RD
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City | OAKWOOD VILLAGE
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State | OH
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Zip | 44146
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Country | US
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Telephone | 216-799-7577
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Fax |
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Provider Business Mailing Address
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Address Line | 25110 TRYON RD
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City | OAKWOOD VILLAGE
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State | OH
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Zip | 44146-6051
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Country | US
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Telephone | 216-799-7577
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN141778-M-IV
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License Number State | OH
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