Individual
MICHELE GLORIA PARADIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN BC
Contact information
Practice address
803 4TH ST, JACKSON, MN 56143-1056
(507) 847-3571
(507) 847-5664
Mailing address
803 4TH ST, JACKSON, MN 56143-1056
(507) 847-3571
(507) 847-5664
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
121976-4
MN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
4704155091
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114832525
—
MI
01
—
5008754170
BCBS
MI
Enumeration date
05/12/2006
Last updated
10/06/2011
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