Provider Demographics
NPI:1588401012
Name:GEBHARDT, MICHELE ANNE
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:ANNE
Last Name:GEBHARDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:A
Other - Last Name:GEBHARDT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, CCM
Mailing Address - Street 1:7412 EAGLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3408
Mailing Address - Country:US
Mailing Address - Phone:937-304-9776
Mailing Address - Fax:
Practice Address - Street 1:4881 SUGAR MAPLE DR
Practice Address - Street 2:
Practice Address - City:WRIGHT PATTERSON AFB
Practice Address - State:OH
Practice Address - Zip Code:45433-5529
Practice Address - Country:US
Practice Address - Phone:937-713-2059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.295050163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management