Provider Demographics
NPI:1366716045
Name:LAUDICK, MICHELLE LEIGH (FNP C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEIGH
Last Name:LAUDICK
Suffix:
Gender:F
Credentials:FNP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9907 SCOTCH PINE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-5218
Mailing Address - Country:US
Mailing Address - Phone:937-631-1925
Mailing Address - Fax:513-603-6241
Practice Address - Street 1:9050 CENTRE POINTE DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-4874
Practice Address - Country:US
Practice Address - Phone:937-631-1925
Practice Address - Fax:513-603-6212
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-28
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN310686363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner