Healthcare Provider Details

I. General information

NPI: 1710008354
Provider Name (Legal Business Name): MS. MICHELLE LEE KLINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MAMC
TACOMA WA
98431-0001
US

IV. Provider business mailing address

230 YUMMERDALL RD
LITITZ PA
17543-7421
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-2700
  • Fax:
Mailing address:
  • Phone: 573-823-4213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: