Provider Demographics
NPI:1376954388
Name:WISCHMEYER, MICHELLE MARIE (DOM, LMT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:WISCHMEYER
Suffix:
Gender:F
Credentials:DOM, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19506 MAYAN ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERLAND KEY
Mailing Address - State:FL
Mailing Address - Zip Code:33042-3143
Mailing Address - Country:US
Mailing Address - Phone:305-923-3124
Mailing Address - Fax:
Practice Address - Street 1:19506 MAYAN ST
Practice Address - Street 2:
Practice Address - City:SUMMERLAND KEY
Practice Address - State:FL
Practice Address - Zip Code:33042-3143
Practice Address - Country:US
Practice Address - Phone:305-923-3124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3448171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist