Provider Demographics
NPI:1649645938
Name:CHIN, MICHELLE LEE (ARNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:CHIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6933 W EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8616
Mailing Address - Country:US
Mailing Address - Phone:208-321-0634
Mailing Address - Fax:208-321-1082
Practice Address - Street 1:6933 W EMERALD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8616
Practice Address - Country:US
Practice Address - Phone:208-321-0634
Practice Address - Fax:208-321-1082
Is Sole Proprietor?:No
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-1665A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1265565477Medicaid