Provider Demographics
NPI:1376537548
Name:UNREIN, MICHAELA M (ARNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MICHAELA
Middle Name:M
Last Name:UNREIN
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4231
Mailing Address - Country:US
Mailing Address - Phone:419-479-5327
Mailing Address - Fax:
Practice Address - Street 1:1100 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:OH
Practice Address - Zip Code:43469-9723
Practice Address - Country:US
Practice Address - Phone:419-724-5820
Practice Address - Fax:419-724-5821
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2022-02-07
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-18
Provider Licenses
StateLicense IDTaxonomies
WI128421363LA2200X
OHAPRN.CNP.15864363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1376537548Medicaid
WIS55593Medicare UPIN
WI0310 68086Medicare PIN