Provider Demographics
NPI:1578255212
Name:FLEURY, MICHELLE LEE (MSN, MSM, RN, CNL)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:FLEURY
Suffix:
Gender:F
Credentials:MSN, MSM, RN, CNL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 S EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-4338
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:708 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-4338
Practice Address - Country:US
Practice Address - Phone:408-832-4451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704400277163W00000X
IL041.533271163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse