Provider Demographics
NPI:1568697571
Name:ANDRUS WILLS, MICHELLE ELIZABETH (IDMT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ELIZABETH
Last Name:ANDRUS WILLS
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 41
Mailing Address - Street 2:BOX 6004
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09464-9998
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PSC 41
Practice Address - Street 2:BOX 6004
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09464-9998
Practice Address - Country:US
Practice Address - Phone:0777-529-6198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians