Provider Demographics
NPI:1598048464
Name:DOLSON, MICHELLE C (NP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:C
Last Name:DOLSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:C
Other - Last Name:BRUDEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:9340 TELEGRAPH RD
Mailing Address - Street 2:SUITE 724
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-3362
Mailing Address - Country:US
Mailing Address - Phone:313-295-3388
Mailing Address - Fax:313-295-4198
Practice Address - Street 1:9340 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3362
Practice Address - Country:US
Practice Address - Phone:313-295-3388
Practice Address - Fax:313-295-4198
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704186908363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner