Individual
MICHELLE MARIE SPONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
500 UNIVERSITY DR, HERSHEY, PA 17033-2360
(800) 243-1455
Mailing address
PO BOX 858, MC A410, HERSHEY, PA 17033-0858
(800) 243-1455
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA003417L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50053698
CAPITAL BLUE CROSS
PA
Enumeration date
02/09/2006
Last updated
05/05/2011
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