Doctor Name: | MRS. MICHELLE MARIE CIVELLO |
NPI Number: | 1396051868 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | N.P. |
License Number: | AP06133 |
Business Practice Address: | 28050 Walker South Rd Walker, LA - 707856047 |
Business Phone Number: | 2256642111 |
Business Fax Number: | 2256642888 |
Mailing Address: | 28050 Walker South Rd, WALKER |
State: | LA |
Postal Code: | 707856047 |
Phone Number: | 2256642111 |
Fax Number: | 2256642888 |
NPI Enumeration Date: | 08/23/2010 |
NPI Last Update Date: | 08/23/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | AP06133 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |