Healthcare Provider Details

I. General information

NPI: 1124584891
Provider Name (Legal Business Name): MICHELLE RENEE NANAS LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 E ELDER ST STE H
FALLBROOK CA
92028-3079
US

IV. Provider business mailing address

577 E ELDER ST STE H
FALLBROOK CA
92028-3079
US

V. Phone/Fax

Practice location:
  • Phone: 760-645-3447
  • Fax: 951-200-4396
Mailing address:
  • Phone: 760-645-3447
  • Fax: 951-200-4396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number557
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: