Provider Demographics
NPI:1124646161
Name:DRAKE, MICHELLE LEANN (RN)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LEANN
Last Name:DRAKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 SANDY CREEK CT
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76085-8236
Mailing Address - Country:US
Mailing Address - Phone:575-746-7433
Mailing Address - Fax:
Practice Address - Street 1:912 W CASTLEBERRY RD
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-9317
Practice Address - Country:US
Practice Address - Phone:575-365-5512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR47163163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse