MEDICARE: MS. MICHELLE F VALLEJOS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	28206889A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	28206889A	OTHER	IN	REGISTERED NURSE LICENSE

General Provider Information

NPI Number	:	1437769510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE F VALLEJOS

Provider Business Mailing Address
First Line	:	9653 DENSION LN
Second Line	:
City	:	NEW HAVEN
State	:	IN
Zip	:	46774-3140
Country	:	US
Telephone Number	:	260-704-6644
Fax Number	:

Provider Business Practice Location Address
First Line	:	9653 DENSION LN
Second Line	:
City	:	NEW HAVEN
State	:	IN
Zip	:	46774-3140
Country	:	US
Telephone Number	:	260-704-6644
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2020
Last Update Date	:	08/04/2020

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