Healthcare Provider Details

I. General information

NPI: 1063358471
Provider Name (Legal Business Name): MICHELE LYNN MAINES MSN, RN, CNS, CNL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD PLZ
LOS ANGELES CA
90095-8358
US

IV. Provider business mailing address

757 WESTWOOD PLZ
LOS ANGELES CA
90095-8358
US

V. Phone/Fax

Practice location:
  • Phone: 310-267-8936
  • Fax:
Mailing address:
  • Phone: 310-267-8936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number5069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: