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General NPI Number Information
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NPI Number | 1184239311
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Entity Type | Organization
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Legal Business Name | MICHAEL THEY
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Dates
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Enumeration Date | 09/14/2020
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Last Update Date | 09/14/2020
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Provider Practice Location Address
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Address Line | 802 14TH ST STE N
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City | MODESTO
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State | CA
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Zip | 95354-1029
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Country | US
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Telephone | 209-718-6240
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Fax | 833-796-8758
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Provider Business Mailing Address
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Address Line | PO BOX 576649
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City | MODESTO
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State | CA
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Zip | 95357-6649
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Country | US
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Telephone | 209-845-2553
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Fax | 209-844-0334
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Authorized Official
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Title or Position | MANAGER
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Name | GINA WALLACE
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Credential |
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Telephone | 209-845-2553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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