Provider Demographics
NPI:1669756805
Name:DAHL, MICHELE DONISE (CPNP)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:DONISE
Last Name:DAHL
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:DONISE
Other - Last Name:HOLWERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1111 RAINTREE CIR STE 240
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4902
Mailing Address - Country:US
Mailing Address - Phone:214-644-0280
Mailing Address - Fax:214-644-0294
Practice Address - Street 1:1111 RAINTREE CIR STE 240
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4902
Practice Address - Country:US
Practice Address - Phone:214-644-0280
Practice Address - Fax:214-644-0294
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX601191363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129982807Medicaid