Provider Demographics
NPI:1770767238
Name:BASILIERE, MICHELE S (MS, CGC)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:S
Last Name:BASILIERE
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 VIVIGEN WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5600
Mailing Address - Country:US
Mailing Address - Phone:508-438-2250
Mailing Address - Fax:505-438-2269
Practice Address - Street 1:2000 VIVIGEN WAY
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5600
Practice Address - Country:US
Practice Address - Phone:508-438-2250
Practice Address - Fax:505-438-2269
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS