Provider Demographics
NPI:1497184329
Name:MUNSON-MCCORRY, MICHELLE ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ANN
Last Name:MUNSON-MCCORRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:ANN
Other - Last Name:MUNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1108 BALLARD ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-5301
Mailing Address - Country:US
Mailing Address - Phone:517-256-5026
Mailing Address - Fax:
Practice Address - Street 1:1108 BALLARD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906
Practice Address - Country:US
Practice Address - Phone:517-256-5026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2485408980163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse