Provider Demographics
NPI:1003231705
Name:ELLIOTT, MICHELLE SLUDER (FNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SLUDER
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:S
Other - Last Name:DUCKWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:2659 US HIGHWAY 70 E
Mailing Address - Street 2:
Mailing Address - City:VALDESE
Mailing Address - State:NC
Mailing Address - Zip Code:28690-9517
Mailing Address - Country:US
Mailing Address - Phone:828-580-4080
Mailing Address - Fax:828-580-4089
Practice Address - Street 1:2659 US HIGHWAY 70 E
Practice Address - Street 2:
Practice Address - City:VALDESE
Practice Address - State:NC
Practice Address - Zip Code:28690-9517
Practice Address - Country:US
Practice Address - Phone:828-580-4080
Practice Address - Fax:828-580-4089
Is Sole Proprietor?:No
Enumeration Date:2014-03-04
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006780363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1003231705Medicaid