Provider Demographics
NPI:1053163642
Name:MCCUNE, MICHELLE ANN (LPN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:MCCUNE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8045 PLAINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:KIMBOLTON
Mailing Address - State:OH
Mailing Address - Zip Code:43749-9736
Mailing Address - Country:US
Mailing Address - Phone:330-556-8150
Mailing Address - Fax:
Practice Address - Street 1:8045 PLAINFIELD RD
Practice Address - Street 2:
Practice Address - City:KIMBOLTON
Practice Address - State:OH
Practice Address - Zip Code:43749-9736
Practice Address - Country:US
Practice Address - Phone:330-556-8150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH145601164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH145601OtherLICENSED PRACTICAL NURSE