Provider Demographics
NPI:1285870683
Name:FLETCHER, MICHELE KNOX (RT(R)(CT))
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:KNOX
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:RT(R)(CT)
Other - Prefix:MISS
Other - First Name:MICHELE
Other - Middle Name:LYNN
Other - Last Name:KNOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RT(R)(CT)
Mailing Address - Street 1:80 S GIBSON RD
Mailing Address - Street 2:#923
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-2432
Mailing Address - Country:US
Mailing Address - Phone:602-373-1066
Mailing Address - Fax:
Practice Address - Street 1:80 S GIBSON RD
Practice Address - Street 2:#923
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-2432
Practice Address - Country:US
Practice Address - Phone:602-373-1066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101482471C3401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography