Healthcare Provider Details

I. General information

NPI: 1275306508
Provider Name (Legal Business Name): MICHELLE A APPEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE LAMPERT

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17916 BARONOFF AVE
EAGLE RIVER AK
99577-8272
US

IV. Provider business mailing address

5770 COLLEGE DR
ANCHORAGE AK
99504-3044
US

V. Phone/Fax

Practice location:
  • Phone: 907-602-0960
  • Fax:
Mailing address:
  • Phone: 907-602-0960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number2162522
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: