Provider Demographics
NPI:1639747454
Name:ELAM, MICHELLE CATHERINE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:CATHERINE
Last Name:ELAM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12729 COTTONWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-7385
Mailing Address - Country:US
Mailing Address - Phone:503-544-2765
Mailing Address - Fax:
Practice Address - Street 1:820 MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1859
Practice Address - Country:US
Practice Address - Phone:503-544-2765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202111763NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily