Provider Demographics
NPI:1457789133
Name:ANTONE, MICHELLE ELAINE
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ELAINE
Last Name:ANTONE
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 1:333 VALENCIA ST
Mailing Address - Street 2:#240
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-3547
Mailing Address - Country:US
Mailing Address - Phone:415-503-1046
Mailing Address - Fax:415-503-1081
Practice Address - Street 1:333 VALENCIA ST
Practice Address - Street 2:#240
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-3547
Practice Address - Country:US
Practice Address - Phone:415-503-1046
Practice Address - Fax:415-503-1081
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker