Provider Demographics
NPI:1831662253
Name:CARNESECCA, MICHELE LEIGH (RN)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LEIGH
Last Name:CARNESECCA
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 1:714 N 700 WEST CIR
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-5228
Mailing Address - Country:US
Mailing Address - Phone:801-358-0989
Mailing Address - Fax:
Practice Address - Street 1:714 N 700 WEST CIR
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-5228
Practice Address - Country:US
Practice Address - Phone:801-358-0989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10016273163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant