Provider Demographics
NPI:1730325697
Name:POWELL, MICHELLE (ROT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:ROT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:WILKERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ROT
Mailing Address - Street 1:2940 ROLLINGRIDGE RD
Mailing Address - Street 2:STE 102
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-4231
Mailing Address - Country:US
Mailing Address - Phone:630-579-6500
Mailing Address - Fax:630-579-5860
Practice Address - Street 1:2940 ROLLINGRIDGE RD
Practice Address - Street 2:STE 102
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-4231
Practice Address - Country:US
Practice Address - Phone:630-579-6500
Practice Address - Fax:630-579-5860
Is Sole Proprietor?:No
Enumeration Date:2008-12-26
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other