Provider Demographics
NPI:1902982481
Name:QUALE, MICHELLE MARIE (CNM, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:QUALE
Suffix:
Gender:F
Credentials:CNM, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 HENNEPIN AVE. NORTH
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:MN
Mailing Address - Zip Code:55336
Mailing Address - Country:US
Mailing Address - Phone:320-864-3121
Mailing Address - Fax:320-864-7877
Practice Address - Street 1:1805 HENNEPIN AVE. NORTH
Practice Address - Street 2:GLENCOE REGIONAL HEALTH SERVICES
Practice Address - City:GLENCOE
Practice Address - State:MN
Practice Address - Zip Code:55336
Practice Address - Country:US
Practice Address - Phone:320-864-3121
Practice Address - Fax:320-234-3295
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR129912-4163W00000X
MNCNM0071367A00000X
MN2775363LF0000X
MNR1299124363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN897905700Medicaid
MN897905700Medicaid
MN420000348Medicare ID - Type Unspecified
MNP38809Medicare UPIN