Provider Demographics
NPI:1154792687
Name:PAUL, MICHELLE M (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:M
Last Name:PAUL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 CENTREVILLE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2626
Mailing Address - Country:US
Mailing Address - Phone:703-830-5600
Mailing Address - Fax:703-830-6942
Practice Address - Street 1:6201 CENTREVILLE RD STE 200
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2626
Practice Address - Country:US
Practice Address - Phone:703-830-5600
Practice Address - Fax:703-830-6942
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA002417853363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily