Provider Demographics
NPI:1477224426
Name:VANDERPOOL, MICHELLE LEIOLANI (FNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEIOLANI
Last Name:VANDERPOOL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 E BOGARD RD STE 228
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7185
Mailing Address - Country:US
Mailing Address - Phone:907-215-4846
Mailing Address - Fax:
Practice Address - Street 1:950 E BOGARD RD STE 228
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7185
Practice Address - Country:US
Practice Address - Phone:907-215-4846
Practice Address - Fax:907-215-4847
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK200471363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily