Provider Demographics
NPI:1093020059
Name:MORNEAU, MICHELLE ANNETTE (RN LMT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANNETTE
Last Name:MORNEAU
Suffix:
Gender:F
Credentials:RN LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 FLORA DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-3210
Mailing Address - Country:US
Mailing Address - Phone:217-359-6575
Mailing Address - Fax:
Practice Address - Street 1:209 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3966
Practice Address - Country:US
Practice Address - Phone:217-359-6575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-15
Last Update Date:2010-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.007337225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist