Provider Demographics
NPI:1194064535
Name:WALDRON, MICHELLE MARIE (ARNP)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:MARIE
Last Name:WALDRON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:WALDRON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:1702 CYPRESS WAY
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-9006
Mailing Address - Country:US
Mailing Address - Phone:425-402-8891
Mailing Address - Fax:
Practice Address - Street 1:1413 SW 43RD STREET
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-3356
Practice Address - Country:US
Practice Address - Phone:425-272-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60316871363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner