Provider Demographics
NPI:1144070434
Name:MOSSBARGER, MICHELLE KAY
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KAY
Last Name:MOSSBARGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9097 WAYNE RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:OH
Mailing Address - Zip Code:43466-9844
Mailing Address - Country:US
Mailing Address - Phone:141-930-8164
Mailing Address - Fax:
Practice Address - Street 1:7575 COUNTY ROAD 21
Practice Address - Street 2:
Practice Address - City:RISINGSUN
Practice Address - State:OH
Practice Address - Zip Code:43457-9619
Practice Address - Country:US
Practice Address - Phone:419-308-1643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant