Healthcare Provider Details

I. General information

NPI: 1437769510
Provider Name (Legal Business Name): MS. MICHELLE F VALLEJOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE FERAER JIMENEZ FNP

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9670 CROSSFIELD RD
AVON IN
46123-5587
US

IV. Provider business mailing address

9670 CROSSFIELD RD
AVON IN
46123-5587
US

V. Phone/Fax

Practice location:
  • Phone: 463-210-9544
  • Fax:
Mailing address:
  • Phone: 463-210-9544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28206889A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: