Provider Demographics
NPI:1538595640
Name:PRISNER, MICHELLE S (DNP FNP-BC PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:S
Last Name:PRISNER
Suffix:
Gender:F
Credentials:DNP FNP-BC PMHNP-BC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:S
Other - Last Name:MIZELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:903 OAK ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-4608
Mailing Address - Country:US
Mailing Address - Phone:319-209-2150
Mailing Address - Fax:319-209-2149
Practice Address - Street 1:903 OAK ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-0801
Practice Address - Country:US
Practice Address - Phone:319-209-2150
Practice Address - Fax:319-209-2149
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-20
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG164931363LP0808X
IAA100736363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA8111527Medicaid