Healthcare Provider Details

I. General information

NPI: 1215745369
Provider Name (Legal Business Name): MICHELLE AN EMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 RIDGE PIKE
EAGLEVILLE PA
19403-5708
US

IV. Provider business mailing address

3125 RIDGE PIKE
EAGLEVILLE PA
19403-5708
US

V. Phone/Fax

Practice location:
  • Phone: 610-630-2111
  • Fax: 610-630-4003
Mailing address:
  • Phone: 610-630-2111
  • Fax: 610-630-4003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberA58595440055021
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: