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General NPI Number Information
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NPI Number | 1730411737
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Entity Type | Individual
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Provider Name | MICHELLE RENEE AXIUM APN-BC
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Gender | Female
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Dates
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Enumeration Date | 02/02/2010
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Last Update Date | 03/01/2018
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Provider Practice Location Address
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Address Line | 9354 S ALBANY AVE
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-2420
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Country | US
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Telephone | 708-769-4758
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 GREEN RD
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City | ANN ARBOR
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State | MI
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Zip | 48105-1598
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Country | US
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Telephone | 734-686-6361
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209-007967
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.007967
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License Number State | IL
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