Provider Demographics
NPI:1740053396
Name:FORTON, MICHELLE (PMHNP)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:FORTON
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:WETZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:8510 GOODALE AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5722
Mailing Address - Country:US
Mailing Address - Phone:586-646-3682
Mailing Address - Fax:
Practice Address - Street 1:1525 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-2675
Practice Address - Country:US
Practice Address - Phone:248-373-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704361254163WP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health