Provider Demographics
NPI:1194025213
Name:CARR, MICHELE HOLLEY (RD, CD,DPM)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:HOLLEY
Last Name:CARR
Suffix:
Gender:F
Credentials:RD, CD,DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 DUNNING CT
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8470
Mailing Address - Country:US
Mailing Address - Phone:801-495-0736
Mailing Address - Fax:
Practice Address - Street 1:664 DUNNING CT
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8470
Practice Address - Country:US
Practice Address - Phone:801-495-0736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5765339-4901133V00000X
UT5765339-0501213E00000X
CAE4105213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E41050Medicare PIN
U69269Medicare UPIN