Provider Demographics
NPI:1588265888
Name:LOW, MICHELLE YVONNE
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:YVONNE
Last Name:LOW
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 1:774 HUMBLE RD
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-3133
Mailing Address - Country:US
Mailing Address - Phone:330-633-5589
Mailing Address - Fax:
Practice Address - Street 1:774 HUMBLE RD
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-3133
Practice Address - Country:US
Practice Address - Phone:330-633-5589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0216871Medicaid