Provider Demographics
NPI:1891301198
Name:RADDATZ, MICHELLE LEA (RN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LEA
Last Name:RADDATZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:LEA
Other - Last Name:UPCHURCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:CMR 480 BOX 840
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09128-0009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:US ARMY MEDICAL ACTIVITY-BAVARIA
Practice Address - Street 2:UNIT 28038 ATTN: MCEU-BAV-CRE
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09112
Practice Address - Country:US
Practice Address - Phone:496-371-9464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC136402163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse