MEDICARE: MS. MICHELLE N GOULD RN

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	28208716A	IN

General Provider Information

NPI Number	:	1578203162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE N GOULD RN

Provider Business Mailing Address
First Line	:	1051 CUMBERLAND AVE
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906-1447
Country	:	US
Telephone Number	:	765-607-6411
Fax Number	:

Provider Business Practice Location Address
First Line	:	1051 CUMBERLAND AVE
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906-1447
Country	:	US
Telephone Number	:	765-607-6411
Fax Number	:

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

Provider Enumeration Date	:	03/31/2022
Last Update Date	:	03/31/2022

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