MEDICARE: MR. CHRISTOPHER MICHAEL DONZELL FNP-BC

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	363LF0000X	Family Nurse Practitioner	4704239421	MI

General Provider Information

NPI Number	:	1780932137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER MICHAEL DONZELL FNP-BC

Provider Business Mailing Address
First Line	:	1866 S MOREY RD
Second Line	:
City	:	LAKE CITY
State	:	MI
Zip	:	49651-9190
Country	:	US
Telephone Number	:	231-839-7282
Fax Number	:	231-839-7222

Provider Business Practice Location Address
First Line	:	1866 S MOREY RD
Second Line	:
City	:	LAKE CITY
State	:	MI
Zip	:	49651-9190
Country	:	US
Telephone Number	:	231-839-7282
Fax Number	:	231-839-7222

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

Provider Enumeration Date	:	08/15/2012
Last Update Date	:	10/03/2022

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