Healthcare Provider Details

I. General information

NPI: 1639687643
Provider Name (Legal Business Name): MICHELLE MACDONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 01/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 JACKSON ST
DENVER CO
80206-2761
US

IV. Provider business mailing address

NATIONAL JEWISH HEALTH ATTN: B. SMALL 1400 JACKSON STREET
DENVER CO
80206-2761
US

V. Phone/Fax

Practice location:
  • Phone: 303-388-4461
  • Fax: 303-270-2174
Mailing address:
  • Phone: 303-388-4461
  • Fax: 303-270-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number001
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: