Provider Demographics
NPI:1043587231
Name:WILLETTE, MICHELLE VIRGINIA
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:VIRGINIA
Last Name:WILLETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3081 VAN LN
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-5209
Mailing Address - Country:US
Mailing Address - Phone:775-513-4446
Mailing Address - Fax:775-751-3172
Practice Address - Street 1:3081 VAN LN
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-5209
Practice Address - Country:US
Practice Address - Phone:775-513-4446
Practice Address - Fax:775-751-3172
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner