Healthcare Provider Details

I. General information

NPI: 1093475105
Provider Name (Legal Business Name): MICHAELA FROST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2021
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N CLIPPERT ST
LANSING MI
48912-4701
US

IV. Provider business mailing address

547 WOODFORD ST
NORFOLK VA
23503-5522
US

V. Phone/Fax

Practice location:
  • Phone: 517-999-2273
  • Fax:
Mailing address:
  • Phone: 757-589-3836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601011542
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: