Healthcare Provider Details

I. General information

NPI: 1407521792
Provider Name (Legal Business Name): MICHELLE LYNN DONLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 09/29/2026
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58923 BUSINESS CENTER DR STE E
YUCCA VALLEY CA
92284-7311
US

IV. Provider business mailing address

58923 BUSINESS CENTER DR STE E
YUCCA VALLEY CA
92284-7311
US

V. Phone/Fax

Practice location:
  • Phone: 760-365-7209
  • Fax: 760-228-2887
Mailing address:
  • Phone: 760-365-7209
  • Fax: 760-228-2887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: