Provider Demographics
NPI:1215971460
Name:ELDREDGE, MICHELE A (NP)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:A
Last Name:ELDREDGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 GLEASON ST
Mailing Address - Street 2:CAPE COD HOSPITAL OCCUPATIONAL HEALTH CENTER
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601
Mailing Address - Country:US
Mailing Address - Phone:508-771-1800
Mailing Address - Fax:508-771-6445
Practice Address - Street 1:26 GLEASON ST
Practice Address - Street 2:CAPE COD HOSPITAL OCCUPATIONAL HEALTH CENTER
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601
Practice Address - Country:US
Practice Address - Phone:508-771-1800
Practice Address - Fax:508-771-6445
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA129287363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NP0480OtherBLUE CROSS
S05014Medicare UPIN
NP3255Medicare ID - Type Unspecified