Provider Demographics
NPI:1083708200
Name:PARDEE, MICHELLE LORRAINE (DNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LORRAINE
Last Name:PARDEE
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N INGALLS ST
Mailing Address - Street 2:#3185
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-2003
Mailing Address - Country:US
Mailing Address - Phone:734-647-0132
Mailing Address - Fax:734-647-0351
Practice Address - Street 1:19275 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2220
Practice Address - Country:US
Practice Address - Phone:734-287-2076
Practice Address - Fax:734-287-2731
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704169272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4585836Medicaid
MI5008600970OtherBCBS
MI4631456Medicaid
MI4810116Medicaid
MIP64997Medicare UPIN
MI0M5682008Medicare ID - Type Unspecified
MIN8800003Medicare ID - Type Unspecified