Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | LT 3316 | NH |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 036.131686 | IL |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | L6587 | TX |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | LT 3316 | NH |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | ME143244 | FL |
NPI | 1841264454 |
---|---|
Provider Name | Dr. Michelle Marie Prince |
First Address | Springfield, IL 62701-1041 |
Second Address | Pensacola, FL 32504-8785 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2006 |
Last Update Date | 13/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
162423103 | MEDICAID CSHCN (01) | TX |
1624231-04 | (05) | TX |
1624231-05 | MEDICAID CSHCN - ROT (01) | TX |
1624231-06 | (05) | TX |
8K8547 | BCBS INDIVIDUAL # (01) | TX |