Provider Demographics
NPI:1740424605
Name:GIESE, MICHELLE LOUISE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LOUISE
Last Name:GIESE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:LOUISE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 LONGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-1524
Mailing Address - Country:US
Mailing Address - Phone:434-392-6101
Mailing Address - Fax:434-392-1003
Practice Address - Street 1:400 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1524
Practice Address - Country:US
Practice Address - Phone:434-392-6101
Practice Address - Fax:434-392-1003
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002997363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical