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General NPI Number Information
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NPI Number | 1558034637
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Entity Type | Individual
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Provider Name | MICHELLE JUAT MSN, APRN,FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/26/2021
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 200 OCEANGATE STE 100
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City | LONG BEACH
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State | CA
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Zip | 90802-4317
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Country | US
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Telephone | 888-562-5442
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Fax | 844-861-1929
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Provider Business Mailing Address
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Address Line | 17750 MANA RD
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City | APPLE VALLEY
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State | CA
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Zip | 92307-2162
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Country | US
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Telephone | 760-265-3235
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95018508
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 754784
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License Number State | CA
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