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General NPI Number Information
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NPI Number | 1104872845
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Entity Type | Individual
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Provider Name | MICHELE A ANSORGE PA
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Gender | Female
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | OPC 371 BOX 39
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City | APO
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State | AP
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Zip | 96271
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Country | US
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Telephone | 315-737-1117
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Fax |
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Provider Business Mailing Address
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Address Line | PSC 444 BOX 2636
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City | APO
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State | AP
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Zip | 96297-0027
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Country | US
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Telephone | 315-737-1117
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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 | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | 3041
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110003611
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 9106702
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License Number State | FL
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