Provider Demographics
NPI:1760071930
Name:DEANES, MICHELLE ELAINE (FNP ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ELAINE
Last Name:DEANES
Suffix:
Gender:F
Credentials:FNP ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 TULIP TREE DR
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27921-8330
Mailing Address - Country:US
Mailing Address - Phone:252-619-1456
Mailing Address - Fax:
Practice Address - Street 1:736 BATTLEFIELD BLVD N # BLVEN
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4941
Practice Address - Country:US
Practice Address - Phone:757-490-9388
Practice Address - Fax:757-490-9401
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024180458363LF0000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care