Provider Demographics
NPI:1154561587
Name:DELKETTIE, MICHELLE D (LMP)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:D
Last Name:DELKETTIE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 615
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:WA
Mailing Address - Zip Code:98244-0615
Mailing Address - Country:US
Mailing Address - Phone:509-741-0716
Mailing Address - Fax:
Practice Address - Street 1:2209 ELM ST STE 204
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2855
Practice Address - Country:US
Practice Address - Phone:509-741-0716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00025169174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist