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General NPI Number Information
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NPI Number | 1205292935
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Entity Type | Individual
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Provider Name | MICHELLE ENGDAYEHU RN FNP
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Gender | Female
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Dates
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Enumeration Date | 01/11/2016
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Last Update Date | 11/13/2023
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Provider Practice Location Address
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Address Line | 707 HOLLYBROOK DR
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City | LONGVIEW
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State | TX
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Zip | 75605
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Country | US
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Telephone | 903-291-6149
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Fax | 903-291-6160
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Provider Business Mailing Address
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Address Line | 707 HOLLYBROOK DR
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City | LONGVIEW
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State | TX
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Zip | 75605-2410
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Country | US
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Telephone | 903-291-6161
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Fax | 903-291-6060
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP129817
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License Number State | TX
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