Provider Demographics
NPI:1598782518
Name:PASCARELLA, MICHELL K (APNP)
Entity Type:Individual
Prefix:
First Name:MICHELL
Middle Name:K
Last Name:PASCARELLA
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:1005 PENNSYLVANIA AVE STE 210
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-6414
Practice Address - Country:US
Practice Address - Phone:641-683-3195
Practice Address - Fax:641-686-3197
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1219-033363L00000X
WI1219-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43949400Medicaid
WIK400245716Medicare PIN
P40868Medicare UPIN