Provider Demographics
NPI:1134509300
Name:DUCHARME RAUMA, MICHELE MARIE (APRN, CNP)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:MARIE
Last Name:DUCHARME RAUMA
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:MARIE
Other - Last Name:DUCHARME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:11850 BLACKFOOT ST NW STE 130
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2583
Mailing Address - Country:US
Mailing Address - Phone:763-236-9000
Mailing Address - Fax:763-236-9010
Practice Address - Street 1:2800 CAMPUS DR
Practice Address - Street 2:SUITE 20
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2645
Practice Address - Country:US
Practice Address - Phone:763-398-8710
Practice Address - Fax:763-398-8711
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP3843363L00000X
MN3843363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner