MEDICARE: MICHELLE CORCORAN NP

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	363L00000X	Nurse Practitioner	NP6479C	CA

General Provider Information

NPI Number	:	1881802759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE CORCORAN NP

Provider Business Mailing Address
First Line	:	DEPT LA 21190
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91185-1190
Country	:	US
Telephone Number	:	714-449-4800
Fax Number	:	714-449-4956

Provider Business Practice Location Address
First Line	:	2720 N HARBOR BLVD
Second Line	:	SUITE 300
City	:	FULLERTON
State	:	CA
Zip	:	92835-2609
Country	:	US
Telephone Number	:	714-449-6990
Fax Number	:	714-449-6971

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/09/2007

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