Basic Information
| Provider Information | |||||||||
| NPI: | 1952512113 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BILYEU | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CNA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PENNYWITT | ||||||||
| OtherFirstName: | MICHELLE | ||||||||
| OtherMiddleName: | LEE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 22 E 4TH STREET | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9377796602 | ||||||||
| FaxNumber: | 9375492502 | ||||||||
| Practice Location | |||||||||
| Address1: | 22 E 4TH STREET | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9377796602 | ||||||||
| FaxNumber: | 9375492502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2007 | ||||||||
| LastUpdateDate: | 01/15/2015 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 374U00000X | 377962910299 | OH | Y | Nursing Service Related Providers | Home Health Aide |
ID Information
| ID | Type | State | Issuer | Description | 2267014 | 05 | OH | MEDICAID |