Provider Demographics
NPI:1659531945
Name:LARUE, MICHELLE YVONNE (CSA)
Entity type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:YVONNE
Last Name:LARUE
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8020 MAGNOLIA WAY
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-4281
Mailing Address - Country:US
Mailing Address - Phone:770-330-5549
Mailing Address - Fax:833-672-3232
Practice Address - Street 1:8020 MAGNOLIA WAY
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4281
Practice Address - Country:US
Practice Address - Phone:770-330-5549
Practice Address - Fax:833-672-3232
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZC0007X
TN2632246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant