Provider Demographics
NPI:1376190256
Name:MICHELS, MARILYN ANN (MSN RN CRRN)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:ANN
Last Name:MICHELS
Suffix:
Gender:F
Credentials:MSN RN CRRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N7015 SUNRISE LN
Mailing Address - Street 2:
Mailing Address - City:HOLMEN
Mailing Address - State:WI
Mailing Address - Zip Code:54636-9417
Mailing Address - Country:US
Mailing Address - Phone:608-526-2415
Mailing Address - Fax:
Practice Address - Street 1:N7015 SUNRISE LN
Practice Address - Street 2:
Practice Address - City:HOLMEN
Practice Address - State:WI
Practice Address - Zip Code:54636-9417
Practice Address - Country:US
Practice Address - Phone:608-526-2415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-24
Last Update Date:2019-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI74267-303747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider