Individual
MICHELLE RAEGENE BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
246ZS0400X
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50416
ATHEM
CO
01
—
5214875
CIGNA
CO
Enumeration date
03/19/2007
Last updated
07/08/2007
Update your record
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