Provider Demographics
NPI:1013783026
Name:DEAN, MICHELLE MARY (DNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARY
Last Name:DEAN
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 PLATO BLVD W # 200
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55107-2004
Mailing Address - Country:US
Mailing Address - Phone:651-266-2512
Mailing Address - Fax:
Practice Address - Street 1:90 PLATO BLVD W # 200
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-2004
Practice Address - Country:US
Practice Address - Phone:651-266-2512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11023363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health