Provider Demographics
NPI:1639325863
Name:PROSKA, MICHELLE A (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:PROSKA
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:A
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN, CNP
Mailing Address - Street 1:ESSENTIA HEALTH DULUTH CLINIC SSB-5
Mailing Address - Street 2:400 E THIRD STREET
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1951
Mailing Address - Country:US
Mailing Address - Phone:218-786-8364
Mailing Address - Fax:
Practice Address - Street 1:400 E 3RD ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-1951
Practice Address - Country:US
Practice Address - Phone:218-786-3443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1704554363LA2200X
MN3718363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1639325863Medicaid
WI36091400Medicaid
MN500004625Medicare PIN