| Doctor Name: | MICHELLE ENGDAYEHU |
| NPI Number: | 1205292935 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN FNP |
| License Number: | AP129817 |
| Business Practice Address: | 307 W Upshur Ave Gladewater, TX - 756472121 |
| Business Phone Number: | 9038452159 |
| Business Fax Number: | 9038455451 |
| Mailing Address: | 4002 Technology Ctr, LONGVIEW |
| State: | TX |
| Postal Code: | 756052697 |
| Phone Number: | 9032470484 |
| Fax Number: | 9032470485 |
| NPI Enumeration Date: | 01/11/2016 |
| NPI Last Update Date: | 01/11/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | AP129817 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |