Provider Demographics
NPI:1487005435
Name:GREATHOUSE, MICHELLE LYNN (NP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:GREATHOUSE
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 1:13212 STATE HIGHWAY 11
Mailing Address - Street 2:
Mailing Address - City:NOVINGER
Mailing Address - State:MO
Mailing Address - Zip Code:63559-2923
Mailing Address - Country:US
Mailing Address - Phone:309-231-7830
Mailing Address - Fax:
Practice Address - Street 1:191 IOWA BLVD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MO
Practice Address - Zip Code:64683-8343
Practice Address - Country:US
Practice Address - Phone:660-358-5883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016022814363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner