Healthcare Provider Details

I. General information

NPI: 1992773758
Provider Name (Legal Business Name): MICHELLE LYNN PAGE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8788 JAMACHA RD
SPRING VALLEY CA
91977-4035
US

IV. Provider business mailing address

942 EAST MARICOPA DR PO BOX 1504
SPRINGERVILLE AZ
85938-1540
US

V. Phone/Fax

Practice location:
  • Phone: 619-515-2555
  • Fax:
Mailing address:
  • Phone: 928-655-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP0890
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN566238
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2336953
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP171180
License Number StateME
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP11518
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60911397
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: