Provider Demographics
NPI:1720675721
Name:DOUGLAS, MICHELLE LYNNE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LYNNE
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 HEATHER WAY
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19543-8708
Mailing Address - Country:US
Mailing Address - Phone:484-798-7046
Mailing Address - Fax:
Practice Address - Street 1:555 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2207
Practice Address - Country:US
Practice Address - Phone:717-544-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022993363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care