Provider Demographics
NPI:1235792045
Name:BARRETT, MICHELLE ANNA (APRN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANNA
Last Name:BARRETT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 E STATE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2521
Mailing Address - Country:US
Mailing Address - Phone:815-397-3691
Mailing Address - Fax:
Practice Address - Street 1:6000 E STATE ST STE 1
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2521
Practice Address - Country:US
Practice Address - Phone:815-397-3691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.019247363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner