MEDICARE: MICHELLE SETLIFF

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	NP95009131	CA

General Provider Information

NPI Number	:	1164083168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE SETLIFF

Provider Business Mailing Address
First Line	:	820 OFFUTT ST
Second Line	:
City	:	TRAVIS AFB
State	:	CA
Zip	:	94535-1362
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1261 TRAVIS BLVD STE 170
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-4825
Country	:	US
Telephone Number	:	707-399-9200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2019
Last Update Date	:	06/21/2019

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Directions to “ MICHELLE SETLIFF ” Practice Location

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