Provider Demographics
NPI:1396416483
Name:ORE, MICHELLE LANE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LANE
Last Name:ORE
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 1:2400 PRATT ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3976
Mailing Address - Country:US
Mailing Address - Phone:919-668-1002
Mailing Address - Fax:
Practice Address - Street 1:2400 PRATT ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3976
Practice Address - Country:US
Practice Address - Phone:919-668-1002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5018877363L00000X
FLAPRN11021576363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner