Provider Demographics
NPI:1891707386
Name:KOTCELLA, MICHELLE SUZANNE (MSN,FNPC)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:SUZANNE
Last Name:KOTCELLA
Suffix:
Gender:F
Credentials:MSN,FNPC
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:SUZANNE
Other - Last Name:WRONEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN,FNPC
Mailing Address - Street 1:1461 DANIEL LN
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-0320
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1826 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-3620
Practice Address - Country:US
Practice Address - Phone:478-272-1210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN145915363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily