Healthcare Provider Details

I. General information

NPI: 1538539325
Provider Name (Legal Business Name): MICHELLE M. ENGLERT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 12/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 DOWNEY PL
CUBA MO
65453-1640
US

IV. Provider business mailing address

PO BOX 505164
SAINT LOUIS MO
63150-5164
US

V. Phone/Fax

Practice location:
  • Phone: 573-885-3358
  • Fax: 573-885-3361
Mailing address:
  • Phone: 417-829-4620
  • Fax: 417-829-4316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2015034731
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: