Provider Demographics
NPI:1821757014
Name:FLECK, MICHELLE A
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:FLECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:A
Other - Last Name:GOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 617
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25271-0617
Mailing Address - Country:US
Mailing Address - Phone:304-372-2406
Mailing Address - Fax:304-372-9243
Practice Address - Street 1:217 SOUTH STREET
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271
Practice Address - Country:US
Practice Address - Phone:304-372-2406
Practice Address - Fax:304-372-9243
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker