Individual
KENNETH PAUL MICHELETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
72 W JIMMIE LEEDS RD STE 2500, GALLOWAY, NJ 08205-9413
(609) 377-5133
Mailing address
2500 ENGLISH CREEK AVE, EGG HARBOR TOWNSHIP, NJ 08234-5549
(609) 407-2300
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
26NJ01060700
NJ
Other
Enumeration date
10/06/2020
Last updated
10/06/2020
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