Provider Demographics
NPI:1336472208
Name:MICHEL, DEANNA RAE
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:RAE
Last Name:MICHEL
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 1:260 MAIN AVE S
Mailing Address - Street 2:
Mailing Address - City:HARMONY
Mailing Address - State:MN
Mailing Address - Zip Code:55939-6690
Mailing Address - Country:US
Mailing Address - Phone:507-951-8317
Mailing Address - Fax:507-886-1437
Practice Address - Street 1:260 MAIN AVE. S.
Practice Address - Street 2:
Practice Address - City:HARMONY
Practice Address - State:MN
Practice Address - Zip Code:55939-0000
Practice Address - Country:US
Practice Address - Phone:507-951-8317
Practice Address - Fax:507-886-1437
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNZ426279545312172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver