Provider Demographics
NPI:1609852011
Name:ALDRICH, MICHELLE M (CRNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:ALDRICH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 QUINCY AVE STE 2A
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1739
Mailing Address - Country:US
Mailing Address - Phone:570-961-0851
Mailing Address - Fax:570-344-4285
Practice Address - Street 1:748 QUINCY AVE STE 2A
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1739
Practice Address - Country:US
Practice Address - Phone:570-961-0851
Practice Address - Fax:570-344-4285
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN322019L163W00000X
PAVP004318B363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse