Healthcare Provider Details

I. General information

NPI: 1437635232
Provider Name (Legal Business Name): MICHAELA MECLGARTLAND LVN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2018
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 CUTTING BLVD
RICHMOND CA
94804-2554
US

IV. Provider business mailing address

1131 24TH ST APT 109
OAKLAND CA
94607-2453
US

V. Phone/Fax

Practice location:
  • Phone: 510-232-0874
  • Fax:
Mailing address:
  • Phone: 510-563-9037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number95179113
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number282611
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: