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General NPI Number Information
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NPI Number | 1598265563
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Entity Type | Individual
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Provider Name | MRS. MICHELLE ALISHA HIDALGO
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Gender | Female
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Dates
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Enumeration Date | 02/16/2018
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Last Update Date | 02/16/2018
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Provider Practice Location Address
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Address Line | 3330 FANNIN ST
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City | BEAUMONT
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State | TX
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Zip | 77701-3801
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Country | US
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Telephone | 409-832-3325
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Fax |
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Provider Business Mailing Address
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Address Line | 304 S 14TH 1/2 ST
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City | NEDERLAND
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State | TX
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Zip | 77627-4524
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Country | US
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Telephone | 409-718-1624
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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 | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 219536
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License Number State | TX
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