Provider Demographics
NPI:1023348976
Name:BROGDON, MICHELLE CAROL (RN, MSN, ACNP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:CAROL
Last Name:BROGDON
Suffix:
Gender:F
Credentials:RN, MSN, ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16151 19 MILE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1157
Mailing Address - Country:US
Mailing Address - Phone:586-263-2222
Mailing Address - Fax:586-263-2271
Practice Address - Street 1:16151 19 MILE RD STE 120
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1157
Practice Address - Country:US
Practice Address - Phone:586-263-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-28
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704199950363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care