Provider Demographics
NPI:1639199219
Name:MICHAUX, LISA D (APRN, BC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:D
Last Name:MICHAUX
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31815 SOUTHFIELD RD
Mailing Address - Street 2:STE 22
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-5471
Mailing Address - Country:US
Mailing Address - Phone:248-594-3142
Mailing Address - Fax:248-594-3249
Practice Address - Street 1:31815 SOUTHFIELD RD
Practice Address - Street 2:STE 22
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-5471
Practice Address - Country:US
Practice Address - Phone:248-594-3142
Practice Address - Fax:248-594-3249
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704232028363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI08669640OtherBCBSM
MI453943OtherVALUE OPTIONS
MIG42072OtherHAP
MIN94680002Medicare PIN
MI08669640OtherBCBSM