MEDICARE: MICHELLE VANOOSTEN

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	363L00000X	Nurse Practitioner	4704162137	MI

General Provider Information

NPI Number	:	1659616613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE VANOOSTEN

Provider Business Mailing Address
First Line	:	1360 N SAINT HELEN RD
Second Line	:	PO BOX 39
City	:	SAINT HELEN
State	:	MI
Zip	:	48656-9521
Country	:	US
Telephone Number	:	989-826-3271
Fax Number	:

Provider Business Practice Location Address
First Line	:	1360 N SAINT HELEN RD
Second Line	:
City	:	SAINT HELEN
State	:	MI
Zip	:	48656-9521
Country	:	US
Telephone Number	:	989-826-3271
Fax Number	:

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

Provider Enumeration Date	:	12/03/2012
Last Update Date	:	08/25/2015

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Directions to “ MICHELLE VANOOSTEN ” Practice Location

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