Provider Demographics
NPI:1821289232
Name:VAN WYHE, MICHELLE LYNN (MS, ARNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LYNN
Last Name:VAN WYHE
Suffix:
Gender:F
Credentials:MS, ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 LINCOLN CIR SE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-1836
Mailing Address - Country:US
Mailing Address - Phone:712-737-2000
Mailing Address - Fax:712-737-2115
Practice Address - Street 1:1000 LINCOLN CIR SE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-1836
Practice Address - Country:US
Practice Address - Phone:712-737-2000
Practice Address - Fax:712-737-2115
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-105771363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1821289232Medicaid
IA249140004Medicare UPIN