Provider Demographics
NPI:1659507762
Name:MUNYON, MICHELLE L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:L
Last Name:MUNYON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 CENTRAL AVE STE D
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-8347
Mailing Address - Country:US
Mailing Address - Phone:609-926-5000
Mailing Address - Fax:609-926-2020
Practice Address - Street 1:301 CENTRAL AVE STE D
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-8347
Practice Address - Country:US
Practice Address - Phone:609-926-5000
Practice Address - Fax:609-926-2020
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00217600363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0348899OtherGROUP MEDICAID
216927OtherGROUP MEDICARE
NJ232079YEM4OtherMEDICARE PTAN
NJ0348899OtherGROUP MEDICAID