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General NPI Number Information
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NPI Number | 1053650291
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Entity Type | Individual
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Provider Name | MICHELLE MCNAUGHTON CPNP
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Gender | Female
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Dates
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Enumeration Date | 02/07/2013
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Last Update Date | 06/15/2016
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Provider Practice Location Address
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Address Line | 5301 BEAUBIEN STREET
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City | DETROIT
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State | MI
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Zip | 48201
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Country | US
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Telephone | 313-833-4490
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Fax |
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Provider Business Mailing Address
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Address Line | 1462 COBBLESTONE CT
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City | ANN ARBOR
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State | MI
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Zip | 48108-9553
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0222X
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Taxonomy Name | Critical Care Pediatric Nurse Practitioner
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License Number | 4704249813
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License Number State | MI
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