Provider Demographics
NPI:1205354966
Name:DONNELLY, MICHELLE ANGELIC (PA-C)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ANGELIC
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ANGELIC
Other - Last Name:WINTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:635 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27260
Mailing Address - Country:US
Mailing Address - Phone:336-887-0038
Mailing Address - Fax:336-885-8096
Practice Address - Street 1:635 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27260-5017
Practice Address - Country:US
Practice Address - Phone:336-887-0038
Practice Address - Fax:336-885-8096
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-07523363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant