| NPI | 1003233727 |
|---|---|
| Former Name | MICHELLE MARIE DONELLAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MS AT0463) |
| Enumeration Date | 2014-03-19 |
| Last Update Date | 2014-03-19 |