Provider Demographics
NPI:1003064668
Name:BINGLE, MICHELE LYNN (MSED, EDS)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LYNN
Last Name:BINGLE
Suffix:
Gender:F
Credentials:MSED, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 E SOPER RD
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-9497
Mailing Address - Country:US
Mailing Address - Phone:989-269-6406
Mailing Address - Fax:
Practice Address - Street 1:711 E SOPER RD
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-9497
Practice Address - Country:US
Practice Address - Phone:989-269-6406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA5 0442561174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist