Provider Demographics
NPI:1669001988
Name:DISNEY, MICHELLE VIRGINIA (BIRTH AND PP DOULA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:VIRGINIA
Last Name:DISNEY
Suffix:
Gender:F
Credentials:BIRTH AND PP DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8112 ARROWHEAD CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-3083
Mailing Address - Country:US
Mailing Address - Phone:301-471-1653
Mailing Address - Fax:
Practice Address - Street 1:8112 ARROWHEAD CT
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-3083
Practice Address - Country:US
Practice Address - Phone:301-471-1653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula