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NPI Code Detail

MEDICARE: MRS. MICHELLE LYNN BRYANT-HODGES R.N.

MEDICARE: MRS. MICHELLE LYNN BRYANT-HODGES R.N.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse300338OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12425852OTHEROHOHIO INDEPENDENT PROVIDER

General Provider Information

NPI Number : 1174646160
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MICHELLE LYNN BRYANT-HODGES R.N.
Provider Business Mailing Address
First Line : 2897 MLK JR DR
Second Line :
City : CLEVELAND
State : OH
Zip : 44104-4868
Country : US
Telephone Number : 216-337-3203
Fax Number :
Provider Business Practice Location Address
First Line : 1744 PAYNE AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44114-2910
Country : US
Telephone Number : 216-623-6555
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2007
Last Update Date : 12/28/2022

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