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General NPI Number Information
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NPI Number | 1760966139
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Entity Type | Individual
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Provider Name | MICHELLE LEA BAJEMA ARNP
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Gender | Female
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Dates
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Enumeration Date | 09/20/2018
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 4405 7TH AVE SE
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City | LACEY
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State | WA
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Zip | 98503-1062
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Country | US
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Telephone | 360-207-5607
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Fax | 253-442-6160
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Provider Business Mailing Address
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Address Line | PO BOX 3130
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City | LACEY
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State | WA
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Zip | 98509-3130
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Country | US
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Telephone | 360-207-5607
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Fax | 250-442-6160
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP60892325
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License Number State | WA
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