Provider Demographics
NPI:1922247980
Name:CHAUSSEE, MICHELLE A (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:CHAUSSEE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S PLUM ST
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-3306
Mailing Address - Country:US
Mailing Address - Phone:605-624-8643
Mailing Address - Fax:
Practice Address - Street 1:101 S PLUM ST
Practice Address - Street 2:
Practice Address - City:VERMILLION
Practice Address - State:SD
Practice Address - Zip Code:57069-3306
Practice Address - Country:US
Practice Address - Phone:605-624-8643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-16
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0705363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6831830Medicaid
GA1922247980OtherRAILROAD MEDICARE
SD6831830Medicaid