MEDICARE: MICHELLE LAVENDER

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
1	376K00000X	Nurse's Aide	371943240294	OH
2	163WH0200X	Home Health Registered Nurse	371943240204	OH

General Provider Information

NPI Number	:	1558734814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE LAVENDER

Provider Business Mailing Address
First Line	:	2041 FAIRPORT AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45406-3416
Country	:	US
Telephone Number	:	513-501-6503
Fax Number	:

Provider Business Practice Location Address
First Line	:	2041 FAIRPORT AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45406-3416
Country	:	US
Telephone Number	:	513-501-6503
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2015
Last Update Date	:	11/09/2015

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Directions to “ MICHELLE LAVENDER ” Practice Location

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