Provider Demographics
NPI:1255640140
Name:BARONE, MICHELLE DAWN (NP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DAWN
Last Name:BARONE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 EUBANK BLVD NE STE 6
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-4160
Mailing Address - Country:US
Mailing Address - Phone:505-503-8806
Mailing Address - Fax:888-503-8511
Practice Address - Street 1:1524 EUBANK BLVD NE STE 6
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-4160
Practice Address - Country:US
Practice Address - Phone:505-503-8806
Practice Address - Fax:888-503-8511
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP01732363LF0000X
MO2010032824363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1523368Medicaid
NM133770001OtherMEDICARE