Provider Demographics
NPI:1649752312
Name:MCINTOSH, AUBREY MICHELLE (NP)
Entity Type:Individual
Prefix:
First Name:AUBREY
Middle Name:MICHELLE
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 CRESTMOOR DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371
Mailing Address - Country:US
Mailing Address - Phone:810-394-2964
Mailing Address - Fax:
Practice Address - Street 1:904 CRESTMOOR DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-4870
Practice Address - Country:US
Practice Address - Phone:108-394-2964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704247196363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily