Provider Demographics
NPI:1538539325
Name:ENGLERT, MICHELLE M (FNP-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:ENGLERT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 505164
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5164
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:417-829-4316
Practice Address - Street 1:114 DOWNEY PL
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:MO
Practice Address - Zip Code:65453-1640
Practice Address - Country:US
Practice Address - Phone:573-885-3358
Practice Address - Fax:573-885-3361
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2015034731363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1538539325Medicaid
MO132300605Medicare PIN