Doctor Name: | SUSAN MARIE MICHELI |
NPI Number: | 1316924442 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 1445 |
Business Practice Address: | 289 Ireland Ave Ireland Community Hospital Fort Knox, KY - 401215111 |
Business Phone Number: | 5026249007 |
Business Fax Number: | 5026240252 |
Mailing Address: | 289 Ireland Ave, Ireland Community Hospital FORT KNOX |
State: | KY |
Postal Code: | 401215111 |
Phone Number: | 5026249007 |
Fax Number: | 5026240252 |
NPI Enumeration Date: | 12/29/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 1445 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |