Provider Demographics
NPI:1922322684
Name:STREETER, PASHA MECHELLE (ANP-BC)
Entity Type:Individual
Prefix:MRS
First Name:PASHA
Middle Name:MECHELLE
Last Name:STREETER
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 BEMIS RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9307
Mailing Address - Country:US
Mailing Address - Phone:734-434-8025
Mailing Address - Fax:734-434-8009
Practice Address - Street 1:3511 BEMIS RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-9307
Practice Address - Country:US
Practice Address - Phone:734-434-8025
Practice Address - Fax:734-434-8009
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704140668363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health