Michelle Marie Kolassa, RN
Individual provider Active NPI Registered Nurse · Springport, MI
NPI 1104203447 · NPPES record last updated May 6, 2015
Key facts
- NPI
- 1104203447
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 4704239656 (MI)
- Practice address
- 119 Maple St
Springport, MI 49284-9505 - Phone
- (269) 719-9680
- NPI assigned
- May 6, 2015
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704239656 | MI | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 4704239656 | MI | Yes |
Addresses
Primary practice location
119 Maple St
Springport, MI 49284-9505
Mailing address
119 Maple St
Springport, MI 49284-9505
Phone (269) 719-9680
Other providers in Springport, MI
- Jeffrey Gerard Brenner
- Elissa A Ditzel
- Stephanie Ann Johnson
- Kelly Michele Lane
- Lisa Michelle Rae
- Simply Smiles Inc.
All providers in Springport, MI · Registered Nurse in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 6, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.