Provider Demographics
NPI:1417302258
Name:DARNELL, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:DARNELL
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 1:23505 E APPLEWAY AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-6003
Mailing Address - Country:US
Mailing Address - Phone:509-210-0303
Mailing Address - Fax:509-242-3180
Practice Address - Street 1:23505 E APPLEWAY AVE STE 106
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-6003
Practice Address - Country:US
Practice Address - Phone:509-210-0303
Practice Address - Fax:509-242-3180
Is Sole Proprietor?:No
Enumeration Date:2016-04-29
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP - 100362152W00000X
MTOPT-OPT-LIC-2788152W00000X
WAOD60658528152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist