Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 5082 | NV |
N | 213EG0000X | General Practice | 5082 | NV |
N | 1223G0001X | General Practice | 5618-015 | WI |
N | 213EG0000X | General Practice | 5618-015 | WI |
Y | 1223P0221X | Pediatric Dentist | S-62 | MN |
NPI | 1063403319 |
---|---|
Provider Name | Dr. Michele L Tafoya |
First Address | Saint Paul, MN 55108-5113 |
Second Address | Las Vegas, NV 89106-2150 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2005 |
Last Update Date | 13/05/2021 |