Provider Demographics
NPI:1437769510
Name:VALLEJOS, MICHELLE F
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:F
Last Name:VALLEJOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:FERAER
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:9653 DENSION LN
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:IN
Mailing Address - Zip Code:46774-3140
Mailing Address - Country:US
Mailing Address - Phone:260-704-6644
Mailing Address - Fax:
Practice Address - Street 1:9653 DENSION LN
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:IN
Practice Address - Zip Code:46774-3140
Practice Address - Country:US
Practice Address - Phone:260-704-6644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28206889A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28206889AOtherREGISTERED NURSE LICENSE