Provider Demographics
NPI:1699661058
Name:HUERTA, MICHELLE DAWN
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DAWN
Last Name:HUERTA
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 HOO HOO HOLW
Mailing Address - Street 2:
Mailing Address - City:LESTER
Mailing Address - State:WV
Mailing Address - Zip Code:25865-9558
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:156 HOO HOO HOLW
Practice Address - Street 2:
Practice Address - City:LESTER
Practice Address - State:WV
Practice Address - Zip Code:25865-9558
Practice Address - Country:US
Practice Address - Phone:304-731-5404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide