Provider Demographics
NPI:1255098547
Name:ANTONELLI, MICHELE (HEALTH COACH)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:ANTONELLI
Suffix:
Gender:F
Credentials:HEALTH COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 OLDFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-8432
Mailing Address - Country:US
Mailing Address - Phone:559-281-7175
Mailing Address - Fax:
Practice Address - Street 1:1711 OLDFIELD WAY
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-8432
Practice Address - Country:US
Practice Address - Phone:559-281-7175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-21
Last Update Date:2021-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA