Provider Demographics
NPI:1407497027
Name:PAD, MICHELLE ERIN (NP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ERIN
Last Name:PAD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ERIN
Other - Last Name:WORMSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1919 CAMBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1735
Mailing Address - Country:US
Mailing Address - Phone:248-342-4958
Mailing Address - Fax:
Practice Address - Street 1:39595 W 10 MILE RD STE 101
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2948
Practice Address - Country:US
Practice Address - Phone:248-348-1540
Practice Address - Fax:248-697-2591
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704321950163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse