Healthcare Provider Details

I. General information

NPI: 1295837763
Provider Name (Legal Business Name): MICHELLE LYNN GUNNETT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E VALLEY PKWY
ESCONDIDO CA
92025-3048
US

IV. Provider business mailing address

1056 ALICE ST
RAMONA CA
92065-1862
US

V. Phone/Fax

Practice location:
  • Phone: 760-739-2691
  • Fax:
Mailing address:
  • Phone: 760-789-4936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number502980
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: