Healthcare Provider Details

I. General information

NPI: 1730184268
Provider Name (Legal Business Name): MICHELLE LYNN RODRIGUEZ GONZALEZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE LYNN RODRIGUEZ CRNA

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 W MARKHAM ST # 783
LITTLE ROCK AR
72205-7101
US

IV. Provider business mailing address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-8000
  • Fax: 501-526-5148
Mailing address:
  • Phone: 410-328-5492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAC000728
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR168263
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR168263
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC003274
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU-1475
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: