Provider Demographics
NPI:1194704791
Name:GANSHIRT, MICHELE ANN (ARNP)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:ANN
Last Name:GANSHIRT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 DELHI ST STE 3500
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6321
Mailing Address - Country:US
Mailing Address - Phone:563-557-3900
Mailing Address - Fax:
Practice Address - Street 1:1690 ELM ST STE 300
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-3679
Practice Address - Country:US
Practice Address - Phone:563-690-2850
Practice Address - Fax:563-557-8488
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC074700363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA9520OtherMIDLAND'S CHOICE
IAIA0113OtherJOHN DEERE HEALTH PLAN
IA67374OtherHAWK-I
IA11349OtherDEAN HEALTH PLAN