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NPI Code Detail

MEDICARE: MICHELLE MARIE PEHRSON FNP-C

MEDICARE: MICHELLE MARIE PEHRSON FNP-C
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
1363LF0000XFamily Nurse PractitionerNP-1194AID
2363LF0000XFamily Nurse PractitionerAP60513762WA

General Provider Information

NPI Number : 1619224896
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE MARIE PEHRSON FNP-C
Provider Business Mailing Address
First Line : 723 MEMORIAL STREET
Second Line :
City : PROSSER
State : WA
Zip : 99350-1524
Country : US
Telephone Number : 509-786-2222
Fax Number : 509-786-6612
Provider Business Practice Location Address
First Line : 701 DALE AVE
Second Line :
City : BENTON CITY
State : WA
Zip : 99320-5250
Country : US
Telephone Number : 509-588-4075
Fax Number : 509-588-4197
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2012
Last Update Date : 12/30/2014

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