Provider Demographics
NPI:1346783917
Name:FORD, MICHELLE (RN)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3307 EVERGREEN WAY
Mailing Address - Street 2:SUITE 707 # 174
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-2062
Mailing Address - Country:US
Mailing Address - Phone:503-348-2410
Mailing Address - Fax:
Practice Address - Street 1:1006 NE 3RD AVE
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-1640
Practice Address - Country:US
Practice Address - Phone:503-348-2410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201506822RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse