Provider Demographics
NPI:1144982562
Name:SLADE, MICHELLE (LPN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SLADE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:LINDERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:560 TAVERN HILL RD
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-4630
Mailing Address - Country:US
Mailing Address - Phone:423-676-1522
Mailing Address - Fax:
Practice Address - Street 1:560 TAVERN HILL RD
Practice Address - Street 2:
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659-4630
Practice Address - Country:US
Practice Address - Phone:423-676-1522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN95673164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN95673OtherPRACTICAL NURSE LICENSE