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NPI Code Detail

MEDICARE: MRS. MICHELLE LYNN DEGRAAF MSN, ANP, BC

MEDICARE: MRS. MICHELLE LYNN DEGRAAF MSN, ANP, BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse Practitioner4704189387MI

General Provider Information

NPI Number : 1316022577
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MICHELLE LYNN DEGRAAF MSN, ANP, BC
Provider Business Mailing Address
First Line : 1497 LAKESIDE DR
Second Line :
City : HUDSONVILLE
State : MI
Zip : 49426-8486
Country : US
Telephone Number : 616-379-1177
Fax Number :
Provider Business Practice Location Address
First Line : 989 SPAULDING AVE SE
Second Line :
City : ADA
State : MI
Zip : 49301-3701
Country : US
Telephone Number : 616-481-6877
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2006
Last Update Date : 11/14/2011

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