Individual
MICHELLE M GILLMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1201 E MICHIGAN AVE STE 240, JACKSON, MI 49201-1855
(517) 205-1591
Mailing address
PO BOX 67000, DEPARTMENT 272801, DETROIT, MI 48267-2728
(517) 841-7490
(517) 841-6917
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4704211845
MI
363LF0000X
Family Nurse Practitioner
Primary
4704211845
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704211845
STATE LICENSE
MI
Enumeration date
09/06/2007
Last updated
07/21/2022
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