Provider Demographics
NPI:1124679576
Name:MICHAEL, CAREN (APRN-CNP)
Entity type:Individual
Prefix:
First Name:CAREN
Middle Name:
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 PREM PL
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-5737
Mailing Address - Country:US
Mailing Address - Phone:570-575-5363
Mailing Address - Fax:
Practice Address - Street 1:8039 WASHINGTON VILLAGE DR STE 100
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-1877
Practice Address - Country:US
Practice Address - Phone:937-435-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025662363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner