Basic Information
| Provider Information | |||||||||
| NPI: | 1013533819 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VOUDRIE | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | DENISE | ||||||||
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| Credential: | DNP, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 W. MCKINLEY AVE. | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | DECATUR | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2178779442 | ||||||||
| FaxNumber: | 2172331670 | ||||||||
| Practice Location | |||||||||
| Address1: | 321 REGENCY PARK | ||||||||
| Address2: | |||||||||
| City: | O'FALLON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184167970 | ||||||||
| FaxNumber: | 6184167971 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2020 | ||||||||
| LastUpdateDate: | 06/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WX0200X | 041443624 | IL | Y | Nursing Service Providers | Registered Nurse | Oncology |
No ID Information.