Healthcare Provider Details

I. General information

NPI: 1811412992
Provider Name (Legal Business Name): MICHAEL CHANCE HULSEY AGACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24451 HEALTH CENTER DR
LAGUNA HILLS CA
92653-3689
US

IV. Provider business mailing address

119 SANTA LOUISA
IRVINE CA
92606-8853
US

V. Phone/Fax

Practice location:
  • Phone: 949-837-4500
  • Fax:
Mailing address:
  • Phone: 940-389-1398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95027813
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: