Provider Demographics
NPI:1285952556
Name:PRIETO, MICHELLE C (CRNP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:C
Last Name:PRIETO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:C
Other - Last Name:GOULD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:69 WILLIAMS LN
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-3323
Mailing Address - Country:US
Mailing Address - Phone:215-704-5634
Mailing Address - Fax:
Practice Address - Street 1:853 2ND STREET PIKE STE A1
Practice Address - Street 2:
Practice Address - City:RICHBORO
Practice Address - State:PA
Practice Address - Zip Code:18954-1083
Practice Address - Country:US
Practice Address - Phone:215-485-5713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN597795163W00000X
PASP023165363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse