Individual
MRS. SALLY MCINTYRE MICHAUD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NNP-BC
Contact information
Practice address
1500 SOUTH MAIN STREET, FORT WORTH, TX 76104
(817) 702-1166
(817) 702-1405
Mailing address
PO BOX 732973, DALLAS, TX 75373-2973
(817) 702-2450
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
776106
TX
Other
Enumeration date
03/07/2018
Last updated
06/04/2019
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