Provider Demographics
NPI:1427775048
Name:FRY, MICHIYO ENDO
Entity type:Individual
Prefix:
First Name:MICHIYO
Middle Name:ENDO
Last Name:FRY
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 1:3898 DUGANS LNDG
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:OH
Mailing Address - Zip Code:44081-8644
Mailing Address - Country:US
Mailing Address - Phone:440-417-4018
Mailing Address - Fax:
Practice Address - Street 1:3898 DUGANS LNDG
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:OH
Practice Address - Zip Code:44081-8644
Practice Address - Country:US
Practice Address - Phone:440-417-4018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide