Provider Demographics
NPI:1144593955
Name:CORMIER, MICHELLE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:CORMIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:CORMIER
Other - Last Name:BRENNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 555534
Mailing Address - Street 2:
Mailing Address - City:CAMP PENDLETON
Mailing Address - State:CA
Mailing Address - Zip Code:92055-5534
Mailing Address - Country:US
Mailing Address - Phone:760-725-1054
Mailing Address - Fax:
Practice Address - Street 1:5/11 BAS, 43505 A STREET
Practice Address - Street 2:43 AREA
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-5534
Practice Address - Country:US
Practice Address - Phone:760-725-1054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program