Provider Demographics
NPI:1104467786
Name:CELL, MICHAEL A (FNP-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:CELL
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 HEALTH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-1380
Mailing Address - Country:US
Mailing Address - Phone:574-647-1088
Mailing Address - Fax:
Practice Address - Street 1:1021 HILL ST STE 300
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-2744
Practice Address - Country:US
Practice Address - Phone:269-858-3024
Practice Address - Fax:269-273-9040
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704235291363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1104467786Medicaid