Provider Demographics
NPI:1487966115
Name:ASTRUP, MICHELE
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:ASTRUP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:UNDERWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56586-0126
Mailing Address - Country:US
Mailing Address - Phone:218-826-6738
Mailing Address - Fax:218-826-6738
Practice Address - Street 1:21251 CO 35
Practice Address - Street 2:
Practice Address - City:UNDERWOOD
Practice Address - State:MN
Practice Address - Zip Code:56586
Practice Address - Country:US
Practice Address - Phone:218-826-6738
Practice Address - Fax:218-826-6738
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10574201AFC177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging