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NPI Code Detail

MEDICARE: MICHELLE SIDLEY

MEDICARE: MICHELLE SIDLEY
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
1164W00000XLicensed Practical NursePN111282MEDSOH

General Provider Information

NPI Number : 1679974836
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE SIDLEY
Provider Business Mailing Address
First Line : 4726 MAIN AVE
Second Line :
City : ASHTABULA
State : OH
Zip : 44004-6929
Country : US
Telephone Number : 440-992-8552
Fax Number : 440-992-6631
Provider Business Practice Location Address
First Line : 4726 MAIN AVE
Second Line :
City : ASHTABULA
State : OH
Zip : 44004-6929
Country : US
Telephone Number : 440-992-8552
Fax Number : 440-992-6631
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2014
Last Update Date : 09/08/2014

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Directions to “ MICHELLE SIDLEY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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