Provider Demographics
NPI:1598048464
Name:WALD, MICHELLE C (NP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:C
Last Name:WALD
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:C
Other - Last Name:DOLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2211 CROOKS RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-5342
Mailing Address - Country:US
Mailing Address - Phone:636-751-9440
Mailing Address - Fax:515-631-5129
Practice Address - Street 1:2211 CROOKS RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-5342
Practice Address - Country:US
Practice Address - Phone:636-751-9440
Practice Address - Fax:636-751-9440
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704186908363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner