Individual
MICHELLE RENEE ICETON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
6606 LBJ FWY STE 200, DALLAS, TX 75240-6524
(972) 233-1999
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP145784
TX
390200000X
Student in an Organized Health Care Education/Training Program
858492
TX
Other
Enumeration date
10/17/2019
Last updated
05/01/2020
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