Provider Demographics
NPI:1568815447
Name:RHODES, MICHELLE LEE (PA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:RHODES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 EMANCIPATION DRIVE
Mailing Address - Street 2:SURGICAL SERVICE
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23667-0001
Mailing Address - Country:US
Mailing Address - Phone:757-722-9961
Mailing Address - Fax:757-728-3159
Practice Address - Street 1:100 EMANCIPATION DRIVE
Practice Address - Street 2:SURGICAL SERVICE
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23667-0001
Practice Address - Country:US
Practice Address - Phone:757-722-9961
Practice Address - Fax:757-728-3159
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
VA01100005473208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant