Basic Information
| Provider Information | |||||||||
| NPI: | 1104439108 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEBER | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25635 401ST AVE | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553079333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5073813960 | ||||||||
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| Practice Location | |||||||||
| Address1: | 601 W CHANDLER ST | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553072127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5079642271 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2020 | ||||||||
| LastUpdateDate: | 08/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 7464 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.