Provider Demographics
NPI:1548706468
Name:DEMARO, MICHELLE (NP, RN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:DEMARO
Suffix:
Gender:F
Credentials:NP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4321 HARTLEY BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31216-5641
Mailing Address - Country:US
Mailing Address - Phone:478-788-2046
Mailing Address - Fax:
Practice Address - Street 1:3780 EISENHOWER PKWY
Practice Address - Street 2:#5
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-0800
Practice Address - Country:US
Practice Address - Phone:478-785-6455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN156993363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily