Provider Demographics
NPI:1811697758
Name:MICHELLI, MEGAN MARIE (A-GNP-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:MICHELLI
Suffix:
Gender:F
Credentials:A-GNP-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:VANKERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4270 S BROTON RD
Mailing Address - Street 2:
Mailing Address - City:FRUITPORT
Mailing Address - State:MI
Mailing Address - Zip Code:49415-8673
Mailing Address - Country:US
Mailing Address - Phone:231-750-4591
Mailing Address - Fax:
Practice Address - Street 1:4270 S BROTON RD
Practice Address - Street 2:
Practice Address - City:FRUITPORT
Practice Address - State:MI
Practice Address - Zip Code:49415-8673
Practice Address - Country:US
Practice Address - Phone:231-750-4591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704268635363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner