Provider Demographics
NPI:1053567990
Name:DANGLE, MICHELLE MARIE (CRNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:DANGLE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:KESSLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:471 HEPBURN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-6122
Mailing Address - Country:US
Mailing Address - Phone:570-567-5400
Mailing Address - Fax:
Practice Address - Street 1:471 HEPBURN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-6122
Practice Address - Country:US
Practice Address - Phone:570-567-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF344098363LF0000X
PASP010208363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103001701Medicaid
PA718966OtherMEDICARE