1285870683 NPI number — MRS. MICHELE KNOX FLETCHER RT(R)(CT)

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285870683 NPI number — MRS. MICHELE KNOX FLETCHER RT(R)(CT)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLETCHER
Provider First Name:
MICHELE
Provider Middle Name:
KNOX
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RT(R)(CT)
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KNOX
Provider Other First Name:
MICHELE
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RT(R)(CT)
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285870683
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
80 S GIBSON RD
Provider Second Line Business Mailing Address:
#923
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89012-2432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-373-1066
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 S GIBSON RD
Provider Second Line Business Practice Location Address:
#923
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89012-2432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-373-1066
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/06/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2471C3401X , with the licence number:  10148 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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