Provider Demographics
NPI:1699889196
Name:NWABUDIKE, MICHELLE M (CNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:NWABUDIKE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 W 65TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2106
Mailing Address - Country:US
Mailing Address - Phone:952-920-7001
Mailing Address - Fax:952-920-2245
Practice Address - Street 1:3625 W 65TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2106
Practice Address - Country:US
Practice Address - Phone:952-920-7001
Practice Address - Fax:952-920-2245
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 1416871207V00000X
MN2922363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN363826000Medicaid
MN26G91NWOtherBCBS
MN0701644OtherMEDICA
MN500001939Medicare ID - Type Unspecified
P50146Medicare UPIN