Healthcare Provider Details

I. General information

NPI: 1912335225
Provider Name (Legal Business Name): MICHELLE JOYCE DUFFY-RENEAU FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE JOYCE DUFFY FNP

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 04/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 N HIGHLAND SPRINGS AVE SUITE 1-A & 1-B
BANNING CA
92220-3082
US

IV. Provider business mailing address

264 N HIGHLAND SPRINGS AVE
BANNING CA
92220-3082
US

V. Phone/Fax

Practice location:
  • Phone: 951-769-7191
  • Fax:
Mailing address:
  • Phone: 951-769-7191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23655
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: