Provider Demographics
NPI:1508921909
Name:CHRISTIAN, MICHELLE SIMONET (NP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SIMONET
Last Name:CHRISTIAN
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 1:2530 HORIZON DR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-3091
Mailing Address - Country:US
Mailing Address - Phone:651-209-8640
Mailing Address - Fax:651-209-8690
Practice Address - Street 1:2530 HORIZON DR
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-3091
Practice Address - Country:US
Practice Address - Phone:651-209-8640
Practice Address - Fax:651-209-8690
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0324295-21363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNS74540Medicare UPIN