Provider Demographics
NPI:1891544888
Name:VANBLARICOM, MICHELLE (APRN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:VANBLARICOM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 DRIFTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-1729
Mailing Address - Country:US
Mailing Address - Phone:870-480-9953
Mailing Address - Fax:
Practice Address - Street 1:614 E EMMA AVE STE 300
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-4469
Practice Address - Country:US
Practice Address - Phone:479-751-7417
Practice Address - Fax:479-751-2878
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR096821163WN0300X
AR228738363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No163WN0300XNursing Service ProvidersRegistered NurseNephrology