Provider Demographics
NPI:1851733919
Name:MCBRIDE, MICHON ELIZABETH (DNP, PNP)
Entity Type:Individual
Prefix:
First Name:MICHON
Middle Name:ELIZABETH
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:DNP, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S 4TH ST
Mailing Address - Street 2:ROOM 510
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1321
Mailing Address - Country:US
Mailing Address - Phone:612-673-5305
Mailing Address - Fax:612-673-3866
Practice Address - Street 1:250 S 4TH ST
Practice Address - Street 2:ROOM 510
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1321
Practice Address - Country:US
Practice Address - Phone:612-673-5305
Practice Address - Fax:612-673-3866
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP 2525363LP0200X
MNR220801-7363LP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics