Provider Demographics
NPI:1336303072
Name:GIDDINGS, MICHELLE NATALIE (APRN, DNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:NATALIE
Last Name:GIDDINGS
Suffix:
Gender:F
Credentials:APRN, DNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:NATALIE
Other - Last Name:MCCALLUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:112 S. JONES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107
Mailing Address - Country:US
Mailing Address - Phone:702-909-4600
Mailing Address - Fax:702-909-5950
Practice Address - Street 1:112 S. JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107
Practice Address - Country:US
Practice Address - Phone:702-909-4600
Practice Address - Fax:702-909-5950
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN000870363LF0000X, 363LP0808X
NVAPRN000870363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily