Provider Demographics
NPI:1740300375
Name:MUIRHEAD, MICHELE RENEE (LVN)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:RENEE
Last Name:MUIRHEAD
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12346 WEDGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-8844
Mailing Address - Country:US
Mailing Address - Phone:909-936-1573
Mailing Address - Fax:909-421-1096
Practice Address - Street 1:12346 WEDGEWOOD LN
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8844
Practice Address - Country:US
Practice Address - Phone:909-936-1573
Practice Address - Fax:909-421-1096
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 141160324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility