Provider Demographics
NPI:1821622937
Name:OETJENS, MICHELLE (FNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:OETJENS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MONTGOMERY VILLAGE AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3548
Mailing Address - Country:US
Mailing Address - Phone:301-948-0098
Mailing Address - Fax:877-361-4546
Practice Address - Street 1:6 MONTGOMERY VILLAGE AVE STE 402
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3548
Practice Address - Country:US
Practice Address - Phone:301-948-0098
Practice Address - Fax:877-361-4546
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF10190648363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily