| NPI | 1962764662 |
|---|---|
| Former Name | MICHELLE RENEE ANDERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MO 2018008052) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KS 9407922) |
| 207W00000X Ophthalmology (Licence: NE 29823) | |
| 207W00000X Ophthalmology (Licence: IA MD-43231) | |
| Enumeration Date | 2012-06-09 |
| Last Update Date | 2021-11-08 |