Provider Demographics
NPI:1376501114
Name:ASBURY, CHARLOTTE J MICHELS (NP-C)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:J MICHELS
Last Name:ASBURY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:M
Other - Last Name:ASBURY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:545 SCOTLAND ST
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-7042
Mailing Address - Country:US
Mailing Address - Phone:231-838-0688
Mailing Address - Fax:
Practice Address - Street 1:9900 BREN RD E
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9664
Practice Address - Country:US
Practice Address - Phone:866-799-5886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704119979363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4660180 10Medicaid
MI5008703230OtherBCBS PIN
S14769Medicare UPIN
MI4660180 10Medicaid