Provider Demographics
NPI:1093286536
Name:FEARS, MICHELLE DAWN (WHNP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:DAWN
Last Name:FEARS
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:MILHOLLAND-FEARS AND MILHOLLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:18818 23RD AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98445-4295
Mailing Address - Country:US
Mailing Address - Phone:253-948-8008
Mailing Address - Fax:
Practice Address - Street 1:400 15TH AVE SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3750
Practice Address - Country:US
Practice Address - Phone:253-697-1310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60909320207VX0201X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology