Provider Demographics
NPI:1730355488
Name:FITTS, MICHELLE L (PA-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:FITTS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:L
Other - Last Name:FITTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97709-0670
Mailing Address - Country:US
Mailing Address - Phone:541-382-6447
Mailing Address - Fax:541-330-7413
Practice Address - Street 1:2090 NE WYATT CT
Practice Address - Street 2:SUITE 101
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7687
Practice Address - Country:US
Practice Address - Phone:541-382-6447
Practice Address - Fax:541-330-7413
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical