Healthcare Provider Details

I. General information

NPI: 1932752953
Provider Name (Legal Business Name): MICHELLE FICHTNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 WALNUT ST
MCKEESPORT PA
15132-7300
US

IV. Provider business mailing address

4201 WALNUT ST
MCKEESPORT PA
15132-7300
US

V. Phone/Fax

Practice location:
  • Phone: 412-664-1448
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN001738
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: