Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 557 | CA |
NPI | 1124584891 |
---|---|
Provider Name | Michelle Renee Nanas |
First Address | Fallbrook, CA 92028-3079 |
Second Address | Fallbrook, CA 92028-3079 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2019 |
Last Update Date | 18/02/2019 |