Provider Demographics
NPI:1154364230
Name:MICHON, ANNE MARIE (NP)
Entity type:Individual
Prefix:
First Name:ANNE MARIE
Middle Name:
Last Name:MICHON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:26901 BEAUMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:248-577-3313
Mailing Address - Fax:248-577-3302
Practice Address - Street 1:3555 W 13 MILE RD STE N300
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6710
Practice Address - Country:US
Practice Address - Phone:248-551-3302
Practice Address - Fax:248-551-7373
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2024-11-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704176675363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704176675OtherSTATE LICENSE