Provider Demographics
NPI:1225368418
Name:PANE, MICHELE LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LEE
Last Name:PANE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 S PARK TERRACE AVE APT 16-104
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3368
Mailing Address - Country:US
Mailing Address - Phone:303-525-2833
Mailing Address - Fax:
Practice Address - Street 1:5400 S PARK TERRACE AVE APT 16-104
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-3368
Practice Address - Country:US
Practice Address - Phone:303-525-2833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2896363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant