Provider Demographics
NPI:1013337211
Name:MCINTYRE, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 NW 11TH ST STE M201
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-6941
Mailing Address - Country:US
Mailing Address - Phone:541-289-4118
Mailing Address - Fax:541-667-3484
Practice Address - Street 1:600 NW 11TH ST STE E37
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-8604
Practice Address - Country:US
Practice Address - Phone:541-567-5305
Practice Address - Fax:541-667-3487
Is Sole Proprietor?:No
Enumeration Date:2014-04-27
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200742439RN363LF0000X
OR201403682NP-PP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily