Provider Demographics
NPI:1578894382
Name:PAOLI, MICHELE (APNP)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:PAOLI
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:986 WIANECKI RD
Mailing Address - Street 2:
Mailing Address - City:KRONENWETTER
Mailing Address - State:WI
Mailing Address - Zip Code:54455-8407
Mailing Address - Country:US
Mailing Address - Phone:715-551-1256
Mailing Address - Fax:
Practice Address - Street 1:986 WIANECKI RD
Practice Address - Street 2:
Practice Address - City:KRONENWETTER
Practice Address - State:WI
Practice Address - Zip Code:54455-8407
Practice Address - Country:US
Practice Address - Phone:715-551-1256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-18
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI119334030163W00000X
WI1538533363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse