Provider Demographics
NPI:1477049708
Name:RODRIGUEZ, MICHELE LYNN (DNP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:LYNN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:MRS
Other - First Name:MICHELE
Other - Middle Name:LYNN
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MICHELE RODRIGUEZ
Mailing Address - Street 1:200 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4358
Mailing Address - Country:US
Mailing Address - Phone:704-874-1904
Mailing Address - Fax:
Practice Address - Street 1:1875 REMOUNT RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-7413
Practice Address - Country:US
Practice Address - Phone:704-874-0600
Practice Address - Fax:704-865-4758
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRODR-FLFP0B363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology