Provider Demographics
NPI:1114256302
Name:MCMAHON, MICHELE DAWN (ACNP-BC)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:DAWN
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32060 LINDERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-1048
Mailing Address - Country:US
Mailing Address - Phone:248-763-0911
Mailing Address - Fax:
Practice Address - Street 1:32060 LINDERMAN AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-1048
Practice Address - Country:US
Practice Address - Phone:248-763-0911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-17
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704239272363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care