Healthcare Provider Details

I. General information

NPI: 1255118550
Provider Name (Legal Business Name): MICHELLE JACQUELINE NOXSEL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE JACQUELINE LOWE RN

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44B N TU SU LN
BISHOP CA
93514-8058
US

IV. Provider business mailing address

250 N SEE VEE LN
BISHOP CA
93514-8130
US

V. Phone/Fax

Practice location:
  • Phone: 760-873-7611
  • Fax: 760-503-4174
Mailing address:
  • Phone: 760-873-8461
  • Fax: 760-503-4174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95088369
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95019662
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: