Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | APRN01816 | RI |
NPI | 1003243148 |
---|---|
Provider Name | Michelle L Fox |
First Address | Indianapolis, IN 46214-3633 |
Second Address | East Providence, RI 02914-1430 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2013 |
Last Update Date | 02/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
APRN01816 | LICENSE (01) | RI |