Healthcare Provider Details

I. General information

NPI: 1043379977
Provider Name (Legal Business Name): MICHELLE HEARN M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5755 COTTLE RD BLDG 1
SAN JOSE CA
95123-3640
US

IV. Provider business mailing address

5755 COTTLE RD BLDG 1
SAN JOSE CA
95123-3640
US

V. Phone/Fax

Practice location:
  • Phone: 408-972-3338
  • Fax: 408-972-3298
Mailing address:
  • Phone: 408-972-3338
  • Fax: 408-972-3298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: