Provider Demographics
NPI:1407135569
Name:MOMENEE, MICHELLE D (APRN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:D
Last Name:MOMENEE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 QUEEN CITY AVE
Mailing Address - Street 2:WOUND CARE DEPT
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-7121
Mailing Address - Country:US
Mailing Address - Phone:603-663-3630
Mailing Address - Fax:603-663-3669
Practice Address - Street 1:185 QUEEN CITY AVE
Practice Address - Street 2:WOUND CARE DEPT
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-7121
Practice Address - Country:US
Practice Address - Phone:603-663-3630
Practice Address - Fax:603-663-3669
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH045679-23363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner