Provider Demographics
NPI:1659843621
Name:WESTON, MICHELLE L (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:L
Last Name:WESTON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6471 EDGESTONE DR
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-8775
Mailing Address - Country:US
Mailing Address - Phone:616-350-8777
Mailing Address - Fax:
Practice Address - Street 1:6471 EDGESTONE DR
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-8775
Practice Address - Country:US
Practice Address - Phone:616-350-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-01
Last Update Date:2019-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704237663363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care