Provider Demographics
NPI:1518451814
Name:DURM, MICHELLE (PA)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:DURM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:MARTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:2130 W SYCAMORE ST STE 200
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-6461
Practice Address - Country:US
Practice Address - Phone:765-457-4455
Practice Address - Fax:765-457-0056
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant