Provider Demographics
NPI:1689965006
Name:PIETLOCK, MICHELLE MEANY (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MEANY
Last Name:PIETLOCK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 STANTON CHRISTIANA RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2133
Mailing Address - Country:US
Mailing Address - Phone:302-999-9399
Mailing Address - Fax:
Practice Address - Street 1:620 STANTON CHRISTIANA RD
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2133
Practice Address - Country:US
Practice Address - Phone:302-999-9399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0000551363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily