Healthcare Provider Details

I. General information

NPI: 1285870683
Provider Name (Legal Business Name): MICHELE KNOX FLETCHER RT(R)(CT)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELE LYNN KNOX RT(R)(CT)

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 S GIBSON RD #923
HENDERSON NV
89012-2432
US

IV. Provider business mailing address

80 S GIBSON RD #923
HENDERSON NV
89012-2432
US

V. Phone/Fax

Practice location:
  • Phone: 602-373-1066
  • Fax:
Mailing address:
  • Phone: 602-373-1066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License Number10148
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: