1699137349 NPI number — MRS. MICHELLE LYNN DELOREY M.S.E. L.P.C. N.C.C.

Table of content: MRS. MICHELLE LYNN DELOREY M.S.E. L.P.C. N.C.C. (NPI 1699137349)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699137349 NPI number — MRS. MICHELLE LYNN DELOREY M.S.E. L.P.C. N.C.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELOREY
Provider First Name:
MICHELLE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.E. L.P.C. N.C.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NIEUWENHEIS
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699137349
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 486
Provider Second Line Business Mailing Address:
140 W. MAIN STREET SUITE A
Provider Business Mailing Address City Name:
WINNECONNE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54986
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-582-4000
Provider Business Mailing Address Fax Number:
888-845-9581

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1095 MIDWAY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MENASHA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54952-1115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-720-2300
Provider Business Practice Location Address Fax Number:
920-720-3719
Provider Enumeration Date:
03/22/2016

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: 101YM0800X , with the licence number:  5718-125 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 5718 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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