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General NPI Number Information
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NPI Number | 1578104899
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Entity Type | Individual
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Provider Name | MS. MICHELE YVETTE MCINTOSH
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Gender | Female
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Dates
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Enumeration Date | 10/08/2019
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Last Update Date | 02/09/2022
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Provider Practice Location Address
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Address Line | 10902 OLD PRINCESS ANNE RD
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City | PRINCESS ANNE
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State | MD
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Zip | 21853-2940
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Country | US
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Telephone | 410-651-4040
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Fax | 888-843-8455
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Provider Business Mailing Address
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Address Line | PO BOX 1978
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City | SALISBURY
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State | MD
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Zip | 21802-1978
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Country | US
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Telephone | 410-749-1015
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Fax | 410-749-0654
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R161190
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License Number State | MD
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