Provider Demographics
NPI:1700699790
Name:WILLSON, MICHELLE LOUISE (APRN, FNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LOUISE
Last Name:WILLSON
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 276
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84542-0276
Mailing Address - Country:US
Mailing Address - Phone:435-820-0263
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 276
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:UT
Practice Address - Zip Code:84542-0276
Practice Address - Country:US
Practice Address - Phone:435-820-0263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7386494-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily