Healthcare Provider Details

I. General information

NPI: 1124621073
Provider Name (Legal Business Name): MICHELE PACE NELSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 EAST AVE # L-723
LIVERMORE CA
94550-9698
US

IV. Provider business mailing address

7000 EAST AVE # L-723
LIVERMORE CA
94550-9698
US

V. Phone/Fax

Practice location:
  • Phone: 925-495-7087
  • Fax:
Mailing address:
  • Phone: 925-495-7087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number787284
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: