Provider Demographics
NPI:1891540761
Name:GASQUE, MICHELLE BROOKE (CRNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:BROOKE
Last Name:GASQUE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 WINSTEAD CIR
Mailing Address - Street 2:
Mailing Address - City:OWENS CROSS ROADS
Mailing Address - State:AL
Mailing Address - Zip Code:35763-7817
Mailing Address - Country:US
Mailing Address - Phone:256-577-1888
Mailing Address - Fax:
Practice Address - Street 1:2227 DRAKE AVE SW STE 7A
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-6123
Practice Address - Country:US
Practice Address - Phone:256-489-9741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-162823363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily