Provider Demographics
NPI:1164243838
Name:OSELAND, MICHELLE MARIE (CHW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:OSELAND
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13127 HARBOR LANDINGS DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-3904
Mailing Address - Country:US
Mailing Address - Phone:810-240-6740
Mailing Address - Fax:
Practice Address - Street 1:13127 HARBOR LANDINGS DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-3904
Practice Address - Country:US
Practice Address - Phone:810-240-6740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker