Provider Demographics
NPI:1760721575
Name:REMILLARD, MICHELLE (LPN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:REMILLARD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 E BELL RD
Mailing Address - Street 2:1132-2
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-2777
Mailing Address - Country:US
Mailing Address - Phone:602-703-9957
Mailing Address - Fax:
Practice Address - Street 1:1460 E BELL RD
Practice Address - Street 2:1132-2
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-2777
Practice Address - Country:US
Practice Address - Phone:602-703-9957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP024191164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse