Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0102X | Surgical Critical Care | M-12449 | ID |
N | 2086S0102X | Surgical Critical Care | MD60080540 | WA |
Y | 2086S0102X | Surgical Critical Care | Q6576 | TX |
N | 2086S0127X | Trauma Surgeon | MD60080540 | WA |
N | 2086S0127X | Trauma Surgeon | Q6576 | TX |
NPI | 1285766121 |
---|---|
Provider Name | Michelle Lynnne Strong |
First Address | Meridian, ID 83642-1026 |
Second Address | Tyler, TX 75701-2036 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 24/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1K9117 | MEDICARE (01) | TX |
361833203 | (05) | TX |