Provider Demographics
NPI:1386259554
Name:MICHALSKI, HEATHER M
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:MICHALSKI
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 1:2823 FOREST LN
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-1552
Mailing Address - Country:US
Mailing Address - Phone:440-865-9995
Mailing Address - Fax:
Practice Address - Street 1:2823 FOREST LN
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1552
Practice Address - Country:US
Practice Address - Phone:440-865-9995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4705900372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion