MEDICARE: MICHELLE VANESSA AHMETI APRN, CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	R40129	ND
2	367500000X	Certified Registered Nurse Anesthetist	203515	ND

General Provider Information

NPI Number	:	1619655784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE VANESSA AHMETI APRN, CRNA

Provider Business Mailing Address
First Line	:	3746 6TH ST E
Second Line	:
City	:	WEST FARGO
State	:	ND
Zip	:	58078-5439
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3746 6TH ST E
Second Line	:
City	:	WEST FARGO
State	:	ND
Zip	:	58078-5439
Country	:	US
Telephone Number	:	915-203-6464
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2023
Last Update Date	:	11/05/2025

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