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General NPI Number Information
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NPI Number | 1013675073
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Entity Type | Individual
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Provider Name | MICHELLE PAIGE BIRDSALL FNP
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Gender | Female
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Dates
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Enumeration Date | 12/07/2021
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 18300 ROSCOE BLVD
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City | NORTHRIDGE
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State | CA
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Zip | 91325-4105
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Country | US
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Telephone | 818-885-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 1722 ROGERS PL UNIT 25E
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City | BURBANK
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State | CA
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Zip | 91504-3668
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Country | US
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Telephone | 407-928-5206
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95018773
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License Number State | CA
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