Provider Demographics
NPI:1447235510
Name:MEINHART, MICHELE (FNP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:MEINHART
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-3614
Mailing Address - Country:US
Mailing Address - Phone:540-389-0110
Mailing Address - Fax:540-344-7154
Practice Address - Street 1:4910 VALLEY VIEW BLVD.
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012
Practice Address - Country:US
Practice Address - Phone:540-265-1604
Practice Address - Fax:540-265-1684
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024125718363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010038278Medicaid
P00062019OtherMEDICARE RAILROAD
VA1447235510Medicaid
S48453Medicare UPIN
P00062019OtherMEDICARE RAILROAD
VA1447235510Medicaid