Provider Demographics
NPI:1679250997
Name:GILES, MICHELLE LYNN (RN BSN CCM)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:GILES
Suffix:
Gender:F
Credentials:RN BSN CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2342 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:SAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83860-8705
Mailing Address - Country:US
Mailing Address - Phone:406-855-3667
Mailing Address - Fax:
Practice Address - Street 1:2342 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:SAGLE
Practice Address - State:ID
Practice Address - Zip Code:83860-8705
Practice Address - Country:US
Practice Address - Phone:406-855-3667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID62875163WC0400X
WARN60808155163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management