Provider Demographics
NPI:1013452333
Name:BROWN, MICHELLE A
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:A
Other - Last Name:PHILPOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:4784 AMBER VALLEY PKWY S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8614
Mailing Address - Country:US
Mailing Address - Phone:701-237-8072
Mailing Address - Fax:
Practice Address - Street 1:600 MAIN AVE S
Practice Address - Street 2:
Practice Address - City:BAUDETTE
Practice Address - State:MN
Practice Address - Zip Code:56623-2855
Practice Address - Country:US
Practice Address - Phone:218-634-1655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP4929363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily