Healthcare Provider Details

I. General information

NPI: 1366126872
Provider Name (Legal Business Name): MICHELLE LOUISE MITCHELL HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE LOUISE WEAVER

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 S MAIN ST
ZELIENOPLE PA
16063-2504
US

IV. Provider business mailing address

580 HOWARD AVE
SOMERSET NJ
08873-1113
US

V. Phone/Fax

Practice location:
  • Phone: 724-452-5340
  • Fax: 724-631-1009
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberF03898
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: