Provider Demographics
NPI:1902130271
Name:DAVIS, MICHELE LYNN
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:LYNN
Other - Last Name:TILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6381 DARLINGTON SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:BELLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44813-9284
Mailing Address - Country:US
Mailing Address - Phone:419-512-5112
Mailing Address - Fax:419-886-2780
Practice Address - Street 1:6381 DARLINGTON SOUTH RD
Practice Address - Street 2:
Practice Address - City:BELLVILLE
Practice Address - State:OH
Practice Address - Zip Code:44813-9284
Practice Address - Country:US
Practice Address - Phone:419-512-5112
Practice Address - Fax:419-886-2780
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-19
Last Update Date:2009-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide