Healthcare Provider Details

I. General information

NPI: 1053352120
Provider Name (Legal Business Name): MICHELLE L SIMPSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6672 NEWARK RD
IMLAY CITY MI
48444-9657
US

IV. Provider business mailing address

6672 NEWARK RD
IMLAY CITY MI
48444-9657
US

V. Phone/Fax

Practice location:
  • Phone: 810-724-0591
  • Fax:
Mailing address:
  • Phone: 810-724-0591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704201068
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: