Provider Demographics
NPI:1356696421
Name:UDELHOVEN, MICHELLE LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:UDELHOVEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 49
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:SD
Mailing Address - Zip Code:57555-0049
Mailing Address - Country:US
Mailing Address - Phone:605-856-2295
Mailing Address - Fax:605-856-2755
Practice Address - Street 1:161 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:SD
Practice Address - Zip Code:57555-0049
Practice Address - Country:US
Practice Address - Phone:605-856-2295
Practice Address - Fax:605-856-2755
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical