Provider Demographics
NPI:1548575699
Name:WEDDLE, MICHELLE ELAINE (FNP)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ELAINE
Last Name:WEDDLE
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 1:6582 IVANPAH AVE
Mailing Address - Street 2:
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277-6556
Mailing Address - Country:US
Mailing Address - Phone:757-620-4798
Mailing Address - Fax:
Practice Address - Street 1:1145 STURGIS STREET
Practice Address - Street 2:NAVAL HOSPITAL TWENTYNINE PALMS
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92278-8250
Practice Address - Country:US
Practice Address - Phone:760-830-2190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider