Healthcare Provider Details

I. General information

NPI: 1013452333
Provider Name (Legal Business Name): MICHELLE A BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE A PHILPOT CNP

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 12/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MAIN AVE S
BAUDETTE MN
56623-2855
US

IV. Provider business mailing address

4784 AMBER VALLEY PKWY S
FARGO ND
58104-8614
US

V. Phone/Fax

Practice location:
  • Phone: 218-634-1655
  • Fax:
Mailing address:
  • Phone: 701-237-8072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP4929
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: