Provider Demographics
NPI:1114610706
Name:JAMES, MICHAELA (FNP-C)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:JAMES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:THEDACARE SHAWANO
Mailing Address - Street 2:100 COUNTY ROAD B
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166
Mailing Address - Country:US
Mailing Address - Phone:715-524-2161
Mailing Address - Fax:
Practice Address - Street 1:100 COUNTY ROAD B
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-7072
Practice Address - Country:US
Practice Address - Phone:715-526-2111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14015-33363L00000X
WI14015363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner