Provider Demographics
NPI:1942826185
Name:SPERRY, NATALIE MICHELLE (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:MICHELLE
Last Name:SPERRY
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:MICHELLE
Other - Last Name:MORELLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10004 EAST LIPPINCOTT BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423
Mailing Address - Country:US
Mailing Address - Phone:810-652-6500
Mailing Address - Fax:
Practice Address - Street 1:10004 EAST LIPPINCOTT BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423
Practice Address - Country:US
Practice Address - Phone:810-652-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI202121591363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics