Provider Demographics
NPI:1811581085
Name:DENNIS, MICHELLE DANIELLE (RN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DANIELLE
Last Name:DENNIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 SMITH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3796
Mailing Address - Country:US
Mailing Address - Phone:443-608-9341
Mailing Address - Fax:667-239-1001
Practice Address - Street 1:1330 SMITH AVE STE 10
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3878
Practice Address - Country:US
Practice Address - Phone:443-608-9341
Practice Address - Fax:667-239-1001
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR205856163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR205856OtherN/A
MDR205856OtherNA