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General NPI Number Information
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NPI Number | 1124584891
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Entity Type | Individual
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Provider Name | MICHELLE RENEE NANAS LM, CPM
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Gender | Female
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Dates
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Enumeration Date | 02/18/2019
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Last Update Date | 02/18/2019
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Provider Practice Location Address
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Address Line | 577 E ELDER ST STE H
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City | FALLBROOK
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State | CA
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Zip | 92028-3079
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Country | US
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Telephone | 760-645-3447
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Fax | 951-200-4396
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Provider Business Mailing Address
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Address Line | 577 E ELDER ST STE H
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City | FALLBROOK
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State | CA
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Zip | 92028-3079
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Country | US
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Telephone | 760-645-3447
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Fax | 951-200-4396
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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 | 176B00000X
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Taxonomy Name | Midwife
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License Number | 557
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License Number State | CA
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