Provider Demographics
NPI:1033938410
Name:UPDEGRAFF, MICHELLE LYNNE (MSN, AG-ACNP-BC, RN)
Entity type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:LYNNE
Last Name:UPDEGRAFF
Suffix:
Gender:F
Credentials:MSN, AG-ACNP-BC, RN
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:LYNNE
Other - Last Name:KILGORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 CAMELOT CT
Mailing Address - Street 2:
Mailing Address - City:HONEY BROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19344-9032
Mailing Address - Country:US
Mailing Address - Phone:484-955-4201
Mailing Address - Fax:
Practice Address - Street 1:225 EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3143
Practice Address - Country:US
Practice Address - Phone:610-323-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASPO30241363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology