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General NPI Number Information
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NPI Number | 1780311126
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Entity Type | Individual
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Provider Name | MICHELLE CRYSTAL MANN MSN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/05/2022
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Last Update Date | 10/30/2023
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Provider Practice Location Address
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Address Line | 3031 COMMERCE DR STE A
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City | FORT GRATIOT
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State | MI
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Zip | 48059-4515
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Country | US
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Telephone | 810-292-0557
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Fax | 810-292-0558
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Provider Business Mailing Address
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Address Line | 22026 WILSHIRE CIR
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City | MACOMB
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State | MI
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Zip | 48044-3719
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Country | US
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Telephone | 586-604-8089
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704309421
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License Number State | MI
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