Provider Demographics
NPI:1477539716
Name:BEHNEN, MICHELE (RNCSFNPGNP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:BEHNEN
Suffix:
Gender:F
Credentials:RNCSFNPGNP
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:MCGUIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNCSFNPGNP
Mailing Address - Street 1:1416 CROWN DR
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-2548
Mailing Address - Country:US
Mailing Address - Phone:660-627-5757
Mailing Address - Fax:660-627-5802
Practice Address - Street 1:1510 CROWN DRIVE
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-5047
Practice Address - Country:US
Practice Address - Phone:660-627-3621
Practice Address - Fax:660-627-5798
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO104748363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO424692317Medicaid
MO261019Medicare Oscar/Certification
MO837355555Medicare PIN