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General NPI Number Information
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NPI Number | 1053472449
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Entity Type | Individual
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Provider Name | MICHELLE A FONTENELLE-GILMER M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 9440 W SAHARA AVE STE 237
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City | LAS VEGAS
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State | NV
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Zip | 89117-8821
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Country | US
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Telephone | 702-765-4965
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Fax |
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Provider Business Mailing Address
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Address Line | 9701 ROYAL LAMB DR
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City | LAS VEGAS
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State | NV
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Zip | 89145-8660
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4301077469
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 15137
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License Number State | NV
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