Provider Demographics
NPI:1144601592
Name:PETERSON, MICHELLE FELICE (APRN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:FELICE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:FELICE
Other - Last Name:OROZCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:92 SPRINGVIEW LANE
Mailing Address - Street 2:SOUTH CAROLINA SLEEP MEDICINE
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8153
Mailing Address - Country:US
Mailing Address - Phone:843-871-4006
Mailing Address - Fax:843-871-4074
Practice Address - Street 1:92 SPRINGVIEW LANE
Practice Address - Street 2:SOUTH CAROLINA SLEEP MEDICINE
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485
Practice Address - Country:US
Practice Address - Phone:843-871-4006
Practice Address - Fax:843-871-4074
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19440363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health