Provider Demographics
NPI:1235393315
Name:COOLEY, MICHELLE A (NP-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:COOLEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:A
Other - Last Name:LAING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:4265 45TH ST S STE 200
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-4309
Mailing Address - Country:US
Mailing Address - Phone:182-300-1942
Mailing Address - Fax:
Practice Address - Street 1:12940 ZACH RD
Practice Address - Street 2:
Practice Address - City:BROWNS VALLEY
Practice Address - State:MN
Practice Address - Zip Code:56219-4018
Practice Address - Country:US
Practice Address - Phone:182-300-1942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR21329363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner