Provider Demographics
NPI:1447629985
Name:WEATHERSBY, MICHELLE CHARLOTTE
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:CHARLOTTE
Last Name:WEATHERSBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W MOANA LN
Mailing Address - Street 2:SUITE 104
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4906
Mailing Address - Country:US
Mailing Address - Phone:775-525-0270
Mailing Address - Fax:
Practice Address - Street 1:255 W MOANA LN
Practice Address - Street 2:SUITE 104
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4906
Practice Address - Country:US
Practice Address - Phone:775-525-0270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator