Provider Demographics
NPI:1033444906
Name:KETTLEBOROUGH, MICHELLE S (CLD)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:S
Last Name:KETTLEBOROUGH
Suffix:
Gender:F
Credentials:CLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4019 FEDERAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-2034
Mailing Address - Country:US
Mailing Address - Phone:303-618-4179
Mailing Address - Fax:
Practice Address - Street 1:4019 FEDERAL BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-2034
Practice Address - Country:US
Practice Address - Phone:303-618-4179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-12
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula