Provider Demographics
NPI:1477575033
Name:SPIEKERMEIER, MICHELE A (NP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:A
Last Name:SPIEKERMEIER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 DEMERS AVE
Mailing Address - Street 2:
Mailing Address - City:EAST GRAND FORKS
Mailing Address - State:MN
Mailing Address - Zip Code:56721-1833
Mailing Address - Country:US
Mailing Address - Phone:218-773-5823
Mailing Address - Fax:218-773-5888
Practice Address - Street 1:621 DEMERS AVE
Practice Address - Street 2:
Practice Address - City:EAST GRAND FORKS
Practice Address - State:MN
Practice Address - Zip Code:56721-1833
Practice Address - Country:US
Practice Address - Phone:218-773-5823
Practice Address - Fax:218-773-5888
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR22267363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P12809Medicare UPIN