Individual
MICHELLE RAEGENE BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1200 CHEROKEE ST, UNIT #203, DENVER, CO 80204-3664
(303) 601-5171
(303) 223-0981
Mailing address
5303 E EVANS AVE, SUITE #302, DENVER, CO 80222-5229
(303) 777-3788
(303) 940-7773
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
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