1942826185 NPI number — NATALIE MICHELLE SPERRY CPNP-PC

Table of content: NATALIE MICHELLE SPERRY CPNP-PC (NPI 1942826185)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942826185 NPI number — NATALIE MICHELLE SPERRY CPNP-PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPERRY
Provider First Name:
NATALIE
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPNP-PC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORELLO
Provider Other First Name:
NATALIE
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1942826185
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13368 PATRICK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINDEN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48451-8477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-752-5628
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
820 BYRON RD STE 600
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOWELL
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48843-1072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-652-6500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/23/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  202121591 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)