Provider Demographics
NPI:1730912247
Name:JUERGENS, MICHAEL ALAN
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALAN
Last Name:JUERGENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W SILVER ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-2778
Mailing Address - Country:US
Mailing Address - Phone:513-372-2913
Mailing Address - Fax:
Practice Address - Street 1:210 W SILVER ST UNIT B
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-2778
Practice Address - Country:US
Practice Address - Phone:513-372-2913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No347C00000XTransportation ServicesPrivate Vehicle
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant