Provider Demographics
NPI:1659616613
Name:VANOOSTEN, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:VANOOSTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 N SAINT HELEN RD
Mailing Address - Street 2:PO BOX 39
Mailing Address - City:SAINT HELEN
Mailing Address - State:MI
Mailing Address - Zip Code:48656-9521
Mailing Address - Country:US
Mailing Address - Phone:989-826-3271
Mailing Address - Fax:
Practice Address - Street 1:1360 N SAINT HELEN RD
Practice Address - Street 2:
Practice Address - City:SAINT HELEN
Practice Address - State:MI
Practice Address - Zip Code:48656-9521
Practice Address - Country:US
Practice Address - Phone:989-826-3271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704162137363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner