Provider Demographics
NPI:1588995989
Name:DEAN, MICHELLE ANN (RN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:DEAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N3279 STATE ROAD 110
Mailing Address - Street 2:
Mailing Address - City:WEYAUWEGA
Mailing Address - State:WI
Mailing Address - Zip Code:54983-8758
Mailing Address - Country:US
Mailing Address - Phone:920-407-2140
Mailing Address - Fax:
Practice Address - Street 1:N3279 STATE ROAD 110
Practice Address - Street 2:
Practice Address - City:WEYAUWEGA
Practice Address - State:WI
Practice Address - Zip Code:54983-8758
Practice Address - Country:US
Practice Address - Phone:920-407-2140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI170493-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse