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General NPI Number Information
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NPI Number | 1912223389
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Entity Type | Individual
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Provider Name | MICHELE ANITA CANTRELL NP
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Gender | Female
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Dates
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Enumeration Date | 04/10/2010
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Last Update Date | 11/18/2022
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Provider Practice Location Address
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Address Line | 1501 TROUSDALE DR 5TH FLOOR
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City | BURLINGAME
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State | CA
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Zip | 94010-4506
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Country | US
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Telephone | 650-652-8787
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Fax |
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Provider Business Mailing Address
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Address Line | 325 DISTEL CIR
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City | LOS ALTOS
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State | CA
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Zip | 94022-1408
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Country | US
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Telephone | 650-652-8700
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 200440425RN
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number | 567223
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 21433
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License Number State | CA
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