Provider Demographics
NPI:1992914469
Name:SMUDDE, MICHELLE LINDSAY (CNMT, RT(N), NCT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LINDSAY
Last Name:SMUDDE
Suffix:
Gender:F
Credentials:CNMT, RT(N), NCT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LINDSAY
Other - Last Name:MACDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNMT, RT(N), NCT
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:HIGLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85236-5500
Mailing Address - Country:US
Mailing Address - Phone:314-629-4548
Mailing Address - Fax:
Practice Address - Street 1:650 E. INDIAN SCHOOL ROAD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1892
Practice Address - Country:US
Practice Address - Phone:314-629-4548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ006742471N0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine Technology