Provider Demographics
NPI:1659576429
Name:FINET, MICHELLE LARISSA (PA)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:LARISSA
Last Name:FINET
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 WATER WHEEL DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPION
Mailing Address - State:PA
Mailing Address - Zip Code:15622-4007
Mailing Address - Country:US
Mailing Address - Phone:412-708-2891
Mailing Address - Fax:
Practice Address - Street 1:575 COAL VALLEY RD STE 374
Practice Address - Street 2:
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-3739
Practice Address - Country:US
Practice Address - Phone:412-469-7744
Practice Address - Fax:412-469-7745
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053001363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA053001OtherSTATE PA LICENSE #