Provider Demographics
NPI:1629368006
Name:POLETTI, MICHELE ERIN
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:ERIN
Last Name:POLETTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:ERIN
Other - Last Name:DOZIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 8323
Mailing Address - Street 2:
Mailing Address - City:NIKISKI
Mailing Address - State:AK
Mailing Address - Zip Code:99635-8323
Mailing Address - Country:US
Mailing Address - Phone:907-776-8541
Mailing Address - Fax:907-776-8541
Practice Address - Street 1:52040 MARLENE AVE
Practice Address - Street 2:
Practice Address - City:NIKISKI
Practice Address - State:AK
Practice Address - Zip Code:99635
Practice Address - Country:US
Practice Address - Phone:907-776-8541
Practice Address - Fax:907-776-8541
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator