Provider Demographics
NPI:1710514161
Name:ALLRED, MICHELLE R (CNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:ALLRED
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59201 BLUFF CR RD
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:MN
Mailing Address - Zip Code:56518
Mailing Address - Country:US
Mailing Address - Phone:218-539-1162
Mailing Address - Fax:
Practice Address - Street 1:415 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-5648
Practice Address - Country:US
Practice Address - Phone:216-631-3510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7323363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily