Basic Information
| Provider Information | |||||||||
| NPI: | 1831321447 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADKISSON | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | HUMEL | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
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| OtherOrganizationName: | |||||||||
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| OtherLastName: | HUMEL | ||||||||
| OtherFirstName: | MICHELE | ||||||||
| OtherMiddleName: | PRUITT | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6444 THORN RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 424208749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704541047 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 170 ALAMEDA DE LAS PULGAS | ||||||||
| Address2: | |||||||||
| City: | REDWOOD CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940622751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503695811 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2009 | ||||||||
| LastUpdateDate: | 08/14/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 242T00000X | 870129 | CA | Y | Technologists, Technicians & Other Technical Service Providers | Perfusionist |
No ID Information.